HomeMy WebLinkAboutFilled Land Affidavit R E C E I V'D MAR 2 4• 2017
PLANNING &DEVELOPMENT SERVICES DEPARTMENT
o 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 pro erty,
7 � �yc�
(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 O wner N e(P se Print)
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OFF 1 U G\
ACKNOWLEDGED BEFORE ME THIS a.� DAY OF m Q ,20 _,
BY C t��Chi t WHO IS PERSONALLY KNOWN TO ME(--)OR WHO HAS
PRODUCED 'C `' `' AS IDENTIFICATION.
SIGNATURE OFN, ARY PUBLIC TYPE OR PRINT NOTARY
EEA9Ot(COMMISSION NUMBER
NA Mp,RIE GNENS
M=ISSIOS#GG U22023
+: = EXPIRES:Decembet Undsrv0
Publie Underwriters
•�7,F�,1S10P: Bonded
lhnt Notary
SLCPDSD Revised 04/11/2011