HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
WIN.
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
follo win describedproperty,
SC>1 940,_-�iF� jAj PALJ-1 C c2y r-�- 3- "o
q q,z5-703-6052 -OCo -q &E16EMO P -o-L%) J_oT y-2�o/2 393,(-fibcjp)
(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.
6M
Property Owner Name(Please Print)
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF M A
ACKNOWLEDGED B ME EFORE THIS 7�DAY OF 1`�AI?_C" 20 L 7 ,
BY K I'v rA f'(M-5411" WHO I _ OWN (_)OR WHO HAS
PRODUCED AS IDENTIFICATION.
DOREEN J.BUFFA
SIGNATURE OF NOTQ Y PWW TYPE OR Q° t'
XPIRES;January 2020
o:
COMMISSION NUMBER
' ;� Bonded Thru Notary Public Underwriter;
(SEAL)
SLCPDSD Revised 04/11/2011