HomeMy WebLinkAboutFilled Land Affidavitf,.-;. :,;;. ;. 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 Idt,t/Legal description/ dress)
-TDQ-
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number
acknowledge
that as owner of the above described property, and in accordance I with Section
7.04.0.1(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.
W- V G 1) fIldcL rA S
Property Owner Name (Please Print)
Property ignatuDate
re I 1 1 Lb
STATE OF FLORIDA. COUNTY OF S'r �W C j G
ACKNOWLEDGED BEFORE ME THIS IV DAY OF NoVtrtit?ar
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BY W 15Irljgh i►click WHO IS PERSONALLY KNOWN TO ME
PRODUCED U OR WHO HAS
AS IDENTIFICATION,
S NATURE OF N I UBL[CIG.�Ae� Q1� JO^N j pN
TYPE OR PRINT NOTARY
"6896911 COMMISSION NUMBER
(SEAL)
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RICHARD DOUGLAS JOHNSON
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SLCPDSD Revised 04/11/2011
Notary Public - Slate of Florida
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My Comm. Expires Mar 20, 2021
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