HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
•I h Building & Code Regulations Division
2300 ,VIRGIMA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner ofthe following described property,
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for which I have applied. to St. Lucie County. for a Final Development Permit. In
accepting this Final Development Permit, BP Number . , 1. acknowledge
:that as owner of the above described property, and: in accordance with Section
7.04.01(D), St. Lucie County Land Development'Code, I shalt be responsible for assuring
adequate drainage so that the immediate communityWILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect
community. the immediate
r� cn A -a N m f
Property Owner .Name (Please Print)
Property ignature
Date
STATE OF FLORIDA, COUNTY OFFS + I . ( j
ACKNOWLEDDGFD UEFORE ME THIS
O DAY OF 20_ 1
BYN. WHO IS PERSONALLY KNOWN TO ME � OR W.HO�—F[AS
PRODUCED _
AS IDENTIFICATION
S NATURE OF N r-AR UHLIC ILNAQ� Clh� JV�NJ ON
TYPE OR�PRINT NOTARY
GG-v84ga.� COMMISSION NUMBER
(SEAL)
"o��•
RICHARD DOUGLASJOH]Aisn.
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SLCPDSD Revised 04/11/2011 [hl�ll
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My Comm. Expires Mar 20.Banded
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