HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
WHOM 2300 VIRGINIA AVENUE
NNW FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the followinj described property,
), sue-/o 1301- 0fo -009'4-ood-6 o I F� wa-P-4w?\- t V�
(Parcel Id#/Legal description/Address) P' peAc Q 51
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.
M oav rceL-p
perty O er Name(Please Print)
Proper Owner Signature Date
STATE OF FLORIDA,COUNTY OF N< DG ��
ACKNOWLEDGED BEFORE ME THIS ` DAY OF ,20
BY a.pk-k—)bO((�� ��D.��.,,n�,,( WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUCED �� _ Y�.� AS IDENTIFICATION.
yslr)." ���• �
ATURE OF NOTARY P L C TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SE-AO: --L4SHAHNAINGRA
FAY Go?u1MISSlON#GG 275060
EXPIRES:December20,2022
� 9 c P: Bonded Th public 0nderr+riiers
' "','•>';K�;�� ru No�ry
SLCPDSD Revised 04/I 1/2011 -