HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
0
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 IM/Le al description/Address)
tion/Address
(P g P )
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.
s LLB
Property Owner Name(Please Print)
3 lu i
operty er Signature Date
STATE OF FLORIDA,COUNTY OF 1 1 r�ti
ACKNOWLEDGED BEFORE ME THIS ' L DAY OFQ/Ir 20 ,
BY U c,cA ri 1 t C—A WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
DUCED (r AS IDENTIFICATION.
SIGN TURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
I ,•••sir P`,''
° ROCHELLE A. DURYEA
MY COMMISSION#FF004610
SLCPDSD Revised 04/11/2011 ,Fonrwo?` EXPIRES April 4,2017
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