HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
1,qr ,5- X19y-xj " 2N/9 '?02 - 000.- 000 •-9
(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 Owner Name (Please Print)
. ' 01 � Property Owner Signature
STATE OF FLORIDA, COUNTY OF a 6AC , 0
iz-il-/7
Date
ACKNOWLEDGED BEFORE ME THIS �- DAY OF U QP 20 1
BY yL V � WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
XODUCEDi. , AS IDENTIFICATION.
SIGNATURE OF NOTARY PU3LIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
Notary Folic - State of Florida
INy Comm. Expires Dec 20, 2018
Commission # FF 177249
Bonded through National Notary Assn, `
SLCPDSD Revised 08/24/2010