HomeMy WebLinkAboutFilled Land Affidavit (2) 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 Fina/DeV-elo Permit. In
accepting this Final Development Permit, BP Numberacknowledge
that as owner of the above described property, and iwith Section
7.04.01(D), St. Lucie County Land-Development Code, I sha for assuring
adequate drainage so that the immediate community WILLely affected.
I further acknowledge that in granting this permit for the evelopment of this property,
St. Lucie County is neither obliged nor liable to prov' e for, or maintain in any form,
adequate drainage off my property which will n adversely affect the immediate
community.
Ivl Yn rYt � -
Property Owner Name(Please Print)
Pro erty Owner Signature Date
STATE OF FLORIDA,COUNTY OF W -t-
ACKNOWLEDGED BEFORE ME IS 14 DAY OF 1 l� 20��,
BY .c Q 1 WHO IS PERSONALLY KNOWN TOME(Y)OR WHO HAS
ED c7' AS IDENTIFICATION.
r�/
SIGN URE OF TTARY PUBLIC TYPE OR PRINT NOTARY c
COMMISSION NUMBER
SEAL
ROCHELLE A..DURYEA
MY COMMISSION#FF004610
SLCPDZevised11/2011 ••.,Fops°Q'' EXPIRES April 4,2017
(40;)398-0153 FlotldnNotaryService.com