HomeMy WebLinkAboutFilled Land Affidavit_-,; _.-• .;;.._, PLANNING & DEVELOPMENT SERVICES DEPARTMENT
• Building & Code Regulations Division
2300 VIRGINIAAVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
arcel ldrY/Legal description/Ad ress)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number
acknowlege
that as owner of the above described property, and in accordance I 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 Coutlty 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.
ft� SProamer Name (Please Print)
Pro er
P tY ignature Date
STATE OF FLORJDA, COUNTY OF
ACKNOWLEDGEDBEFO ME THIS `� DAY OF tcar
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BYy(�N WHO IS PERSONALLY KNOWNYQ ME OR WHO HAS
PRODUCED
{� AS 'IDENTIFICATION
S NATURE OF N rAR UBLIC Vy�1NJOH
TYPE OR PRINT NOTARY
GG-O�COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
(SEAL)
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RICHARD DOUGLAS JOHNSON
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Nalary Public - Siale of Flarida
Com,n,ssior. P GG 084921
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My Comm. Expires Mar 20, 2021
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Bunded hough NAZI-IM Nolary Assn.
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