HomeMy WebLinkAboutFilled Land Affidavit PLANNING&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,
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(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 dr
ainage rainage off my property which will not adversely affect the immediate
community.
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P/06erty OWher Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _DAY OF A i) rl 1
BY � °L CTr%(t 4 VACc YY�iY1 WHO IS PERSONALLY%KNOWN TO ME OR WHO HAS
PRODUCED AS IDENTIFICATION-
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sIGNA RE OF ENO PUBLIC TYPE OR PRINT NOT F4
COMMISSION NUMBER
(SEAL)
BEVERLY,
s WALLACE
MY COMMISSION#GG023777
SLCPDSD Revised 08242010 ,. EXPIRES November 03,2020
I
May 23 2017 12: 31PM HP&SERJET FRX P. 1
2300 Virginia Ave'
Fort Pierce, FL 34982
772-462-2172 -Fax 772-462-6443
CERTIFICATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
PERMIT #: SLC1 704-0468 JOB ADDRESS:18502 Trarsgirility Base Lane,PSL
BUILDERICONTRACTOR: Design Concrete
PEST CONTROL CONTRACTOR: Patrick 'Exterminating
PEST CONTROL LICENSE #: 4864
We,the undersigned, hereby certify that we have pretreated the above described construction for
subterranean termites in accordance with the standards of the National Pest Control Association.
Square feet if area treated: _ 1254 §g ft Chemicals used: Cypermethkin
Percentage of solution: .25% Total gallons used: 125
Date of Treatment: 5/2 3/2 o 17 Time of Treatment:- 12 0 0
i
Footing Sfab
1"Treatment 11�Treatment
Re-Treat Re-Treat
Driveway Pools
1st Treatment 11 Treatment
Re-Treat , Re-Treat.
V Other gCraan rn�m Perimeter for Final Inspection
istTreatment
Re-Treat _
Signature of Exterminator
Note: There must be a completed farm for each required treatment or re-treatment and this form must be on the'job
site:to be picked up by the inspector at time of each Inspection or the scheduled inspection will fall and a re-Inspection
fee charged,
FBC104.2.6 Certificate of Protective Treatment forpt'evention oftennites. A weab5erresis(ant jobsjte posting board
shall be provided to receive duplRate Treatment Certificates as each required protective treatment is completed,
provldmg a copy for Me person the permit is issued to and another copy for the building permit nii es. The Treatment
Certficate shall Provide the product used,identity of the applicator, time and date of the treatment,site location,area
treated,chemical used,percent concentration and number of gallons used,--to establish a verifiable record of
protective treatment. If the soil chemical barrier method for termite prevention Is used, final exterior treatment shall
be completed prior to final building approval.
St Lucie County reyu,ires for the final Inspection for CO,a Permanent Sticker to be placed on
the electrical panel box cover, listing all the treatments and dates of applications.
RECEIVED MAY.2.3, 2017
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