HomeMy WebLinkAboutFilled Land Affidavit L
Y «� 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,
(Parcel Id#/Legal description/Address)
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.
Property Owner Name(Please Print)
"Property Owner Signature Date
STATE OF FLORIDA,COUNTY OFJ
ACKN,.QWLEPGED BEFORE ME THIS _DAY OF
BY WHO IS PERSONALLY KNOWN TO ME L OR WHO HAS
3SGATURE
CED �� 1 1 I lI1� ' �� C' `� O AS IDENTIFICATION.
OF NOTARY P LIC TYPE OR PRINT NOTAART—
COMMISSION NUMBER
LASHAHNA INGRAM
(SEAL) °: Notary public-State of Florida ;
My Comm,Expires Dec 20,
Commissio FF 17201 A "
Bonded throu
qh Nahor,�yl��.„1
SLCPDSD Revised 04/11/2011