HomeMy WebLinkAboutFilled Land Affidavit nANIVII�G&c DEVEILOPMi jT SERVICES_DEPARTMEN'T
BUILDNG.&CODEREGULATION5 DNISIQ_N '
2300 VIRGINIA AN ENUE.
FORT PiF.RCE',FL 34982 565
(772)t62-1553"
FILLED . ANDS AFFIDAVIT
I,_the undersigned;am the.owner of the follotsring described;property;
(Farce!Idn/Legal description/Address)
for which-I, have applied. -o-_St.-Lucie ,County for:a Final Development Pern it. . .In
accept'ia:this Phial Development Nrmit Bp Nii-robe' ; T`abknotiNiledge,
that,as..oiwner of-the::-above described property_. and in ':accordance with Section
7.04,01(p),St.Lucie Coun*yLand Development Code,.I§bail be responsible.for assuring
adequate drainage:so thatthe:irninediate corlimunity WMI LNOT:be adversely affected
,further acknowledge that in=granting th. =permit for�tlie_devtl6inie t:of this:property:- .
St Lucie County is.riehhet_obliged..norliable to proVide.for; or maintain°in any-forma
adequate .drainage 'off m F;property which will 110- adversely .affect'the- itnrnediate
community.
Propert} Owner Name(Please Print)
kA I
' -Piop ner Si_�naturc r Date•
STATE OF FLORIDA.COUNiTy OF
ACKN �VLrDGEDBEF.ORE_,METIHS,2_D.1YOF rL'1 �0k71
-
sY Q v1L�ut LaA V 43�.y�Vj WNO.IS PEFtSOIS AL }Vrl.rO+AF OR VdI?r3 H:1S
PRODUCED A-SS IDENTIFICATION.
SSIGN.TUBE OryF N F, Y PUBLIC TYPE ORPRINT NOTARY
CONNISSION NUMBER ——
ISEVERLY S WALLACE
(SEAL) =' f; '•
MY COMMISSION#GG023777
Zn EXPIRES NOVember 03,2020
SLCPDSD'Rceiscd 0SP_4120i0