HomeMy WebLinkAboutFilled Land Affidavit< ; ..r; :_%, PLANNING &DEVELOPMENT SERVICES DEPARTMENT
• Building & Code Regulations Division
2300 VIRGIMA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
13 -101.- 0D3D. DDo
(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
that as owner of the above described property, and in accordance I 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.
r a y) �n S
Property Omer Name (Please Print)
ertyP ignature
Date
STATE OF FLORIDA, COUNTY OF St \V1C � C
ACKNOWLEDGED BEFORE ME THIS
kd DAY OF t4bvA thmber
— 20 aA O
BY W. Y�(¢l1� i�ClCIv,RS
WHO IS PERSONALLY KNOWN TO ME —,
cx , OR WHO HAS
PRODUCED
IDENTIFICATION
S�NATURE OF N r UBLIC
` `AS
ILNAP� Q1� JV�Nd ot4
TYPE OR PRINT NOTARY
G6-0846,11 COMMISSION NUMBER
(SEAL)
•1�µ�'p; A .,
RICHARD DOUGLAS JOHNSON
' • '
NolaryPublic - Siale of Florida
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SLCPDSD Revised 04/11/2011 �rn\l ��Y:
Commssior.MGGOB4921
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My Comm. Expires Mar 10, 2021
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