HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
• Building & Code Regulations Division
2300 VIRGTNIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
DE(: ®� %'
ST. Lucie'County, Permitting
I, the undersigned, am the owner of the following described property,
(Parcel [dry/Legal description/Address)
for which I have applied to St. Lucie County for a Final Developmett Permit. In
accepting this Final Development Permit, BP Number
acknowlege
that as owner . of the above described property, and in accordance I 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.
c� G a MS
Property Owner me (Please Print)
Pro I
P er ty ignature Date
_ lu
STATE OF FLORIDA, COUNTY OF S i I tAC I -e
ACKNOWLEDGED EIEFORE ME THIS ti _ DAY OF i7 C e—
20 Zt7 _
BY W a �a �B 4AS WHO IS PERSONALLY KNOWN TO ME C) 1 OR WHOjF1AS
PRODUCED
AS IDENTIFICATION
S NATUREOFN fAR UBLIC �ILNAQC JO"�NjOH
TYPE OR PRINT NOTARY
&G-0846at COMMISSION NUMBER
(SEAL)
;. ;�µ� p;A •,
°.
SLCPDSD Revised04/11/2011 '�� fi �•�'d
RICHARD DOUGLAS JOHNSON
Nolary Public - Swe of Florida
COmm55iar,pGGOB4921
My Comm. Expires Mar 20.2021
Banded lhrwyh Nalmnal NolarliAssn.