HomeMy WebLinkAboutFilled Land PLANNING & DEVELOPMENT SERVICES DEPARTMENT
, 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 described prope y,
Aj"J� C4�'10 GG Z 30 ge',
/33 -602 -0003-000-61 'n re
(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.
G✓
operty Own N me(Please Print)
8 /
Pro t r ature Date
STATE OF F� RIDA,COUNTY
ACKNOWLEDGED BEFORE ME THIS DAY OF
BY�n� �LLLQ 11 4J4 d Y�/ WHO IS PERSONALLY TO ME(�R WHO HAS
ODU;;L AS IDENTIFICATION.
S PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER vm,�
„f Rg� n#;j '- 1 (SEAL)
-01
4 ;•' pit to P
SLCPDSD Revised 04/1 U201 I �Qd