HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
L�(- �' lo
(Parcel Id#/Legal description/Add er ss)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I 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 shall be responsible for assuring
adequate drainage so that the immediate community WILL 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 the immediate
community.
& I I e' l Qfnda:�Im
Property Owner Name(Please Print)
J_
Prope Owner Signature Date
STATE OF FLORIDA,COUNTY 0 a�g
ACKNOWLEDGED BEFORE ME THIS�_DAY OF 20 %
BY )! �IS PERSONALLY KNOWN TO ME )OR WHO HAS
PRODUC - AS IDENTIFICATION.
Ott 09
SIGNATURE OF NOT Y PUBLIC TYP PRINT NOTARY
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011
*, AUDREY9-HUMPHREY
MMISSION#FF 174772
EXPIRES:March 6,2019
E3ended
Thru Notary Public Underwriters
I
i
i