HomeMy WebLinkAboutFilled Land Affidavit 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 property, V)�D)WhSOn j ( e
(Parcel Id#/Legal description/Address) -a��
for which I have applied to St. Lucie County for a Final Development Permit. Iri
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)
/(7
Prop rty wner Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF Any,Y( 20��,
BY P I1 A WHO IS PERSONALLY KNOWN TO ME 4)OR WHO HAS
PRODUCED AS IDENTIFICATION.
C, I r ' Cs ` C a
SMNAVJWOF NO ARY PUBLIC TYPE OR PRINT NO ARY
E0— of q, U§ COMMISSION NUMBER
Cft Ems M
NOTARY PURY
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STATE OF FLORIDA
SLCPDSD Revised 04/I 1/2011 • COffl W FF%W1
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