HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
'COUNTY Building& Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
RECEIVED
FILLED LAND AFFIDAVIT
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I,the undersigned, am the owner of the following described property,
J L Col bea, vio- lane For- e; ice .-F- v _NMk,
(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 forni;'�
adequate drainage off my property which will not adversely affect the immediate
community.
Property Owner Name(Please Print)
Property Owner Signature Dat
STATE.OF FLORIDA,COUNTY OF
ACKNOWLEDGED
/BEFORE METHIS _DAY OF,J.
20f
BY 1/ //IZ�L' V gi 7A• WHO IS PER ALLY KNOWN TO ME ❑(J OR WHO HAS
PRODU D lr. AS IDENTIFICATION.
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SIGNATURE OF NOT4V PUBLIC TYPC6RPRrNT NOTARY
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011
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rr�N� c; AUDREY B.HUMPHREY
pp MY COMMISSION#GG 300817
EXPIRES:March 6,2023
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