HomeMy WebLinkAboutFilled Lands Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT RECEIVED
Building&Code Regulations Division FEB 0.9 1011
2300 VIRGINIA AVENUE
FORT PIERCE,Fl,34982-5652 Permitting Department
(772)462-1553 St. Lucie County
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner
of the f��o✓✓llowin described property,
(Parcel Id#/Legal descrilition/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.
Property Owner Name(Please Print)
9
Pr erty Owner Signature D to
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE MET IDS�DAY OF 20
BY Q IS PERSONALLY KNOWN TOME CE-31 OR WHO HAS
PRODUCED AS IDENTIFICATION.
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SIGNATURE OF NOTARY-P40LIC7 TYPE OR PRINT NOTARY
COMMISSION NUMBER
,� P�,,, KAREN S. NIELS �
o'`°� ° State of Florida-Notary u i
Commission #GG 207484
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My Commission Expires
°ii���P� June 12, 2022
SLCPDSD Revised 04/1 1120 1 1
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