HomeMy WebLinkAboutFilled Land Affidavit I
1 — PLANNING & DEVELOPMENT SERVICES DEPARTMENT
-�=,�,`�'=�' RECEIVED
Building &Code Regulations Division
2300 VIRGINI A AVENUE
FORT PIERCE,FL 34982-5652 DEC 3 0 2.020
(772)462-1553
Permitting Department
St. Lucie County
FILLED LAND AFFIDAVIT
I the undersigned am the owner of the followin dibed pro ert
g gescrn 001s 1 k
(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)
^ ryn
1r� Q L4 W 110 _-
Prop rtyb Owner Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE E T S DAY OF '�VOIC 120
By IS PERSONALLY KNOWN TO ME[D OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIG ATURE OF NOTARV`PU8LIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
`1pPY PUBS KAREN S. NIELSEN
3e� e<_, State of Florida-Notary Public
=* *= Commission # GG 207484
ofe��:� My.Commission Expires
SLCPDSD Revised 04/11/2011 """"` June 12, 202E