HomeMy WebLinkAboutFilled Land Affidavit i
ST. LUCIE COUNTY
Elm, . BUILDING& ZONING
2300 VIRGINIA AVENUE
® FORT PIERCE,FL.34982-5652
:� o_ •- n 772-462-1553 .
FILLED LANDS AFFIDAVIT
I;the undersigned, am the owner of the following described property:
a4Q2--00 - y166-000--( Zoigej jKd L aX. dlic 9 bl�: 22+:Z3
(Tax 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 Owner Name Property Owner Signature Date
.o
STATE OF FLOR WA.COUNTY OF
ACKNOWLEDGED BEFORE ME THIS. / DAY OF
BY 40 �''S WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION.
AS
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� SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY
(SEAL)
NOTARY PUBLIC 1= COMMISSION NUMBER
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ALBERTO L RORRERO VIRAL
Notary Public
Calvert County.
Maryland -
Icy Commission Expires Mar.5,2018
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