HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
2300 VIRGMA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following describ d property, '
U I t'l
(Parcel Id#/Legal description/Address) 7o
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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(Ple a Print)
L � Z
erty Owner Signature Date
STATE OF FLORIDA,COUNTY OF � �e��;IjC1C
ACKNOWLEDGED BEFORE ME THIS I DAY OF r C 20
BY O IS PERSONALLY KNOWN TO M OR WHO HAS
PRODUCED AS IDENTIFICATION.
S ATURE 2 N-OTARY P C TYPE OR PRINT NOTARY
47� (A 365768COMMISSIONNUMBER
m
(SEAL)
Jahira SWhes•Medina
SLCPDSD Revised 04/11/2011 NOTARY PUBLIC
STATE OF FLORIDA
a Comm#.GG363708
s4ce I�� Expires 8/7/2023