HomeMy WebLinkAboutFilled Land AffIJi
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,
2212-233-0005-000-8 ; 300 N Header Canal RD Fort Pierce, FL 34945
(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.
crty Owner Name/PleasS' Print)
Property Owier!Date
STATE OF FLORIDA, COIR^TY OF_
Nichcif L- simmDnS WHO is PERSONALLY KNOWN TO ME (LfcjfoR WHO HAS
ACKNOWLEDOED BEFORE ME THIS
BY
PRODUCED AS IDENTIFICATION.
(JATURE OF NOTARY PUBLIC
' COMMISSION NUMBER
TYPE OR PRINT NOTARY
KRISTIN BAITSHOLTS
State of Florida-Notary Public
Commission # fi®A^8527
My Commission Expires
February 19, 2023
SLCPDSD Revised 04/11/2011