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 thel following described property,
O yocq- 30 PAm,_O o k)r, &44 tcrcf_ FL
(Parcel Id#/Legal description/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.
Prop Owner Name lease Prtn)
Gn 7
f
Pr erty Owner Signature Da e
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 3 DAY OF 20�,
BY VU S CcZ �) WHO IS PERSONALLY KNOWN TOME OR WHO HAS
PRODUCED 9 sa-C) AS IDENTIFICATION.
<--�\ —,,I� � Sygs)g;k)
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
FV nl-)q-5-1 COMMISSION NUMBER
(SEAL)
DEBORAH STEVENS
* MY COMMISSION#FF OW11
EXPIRES:August 11,2017
SLCPDSD Revised 04/11/2011 N�AfFOFFt�\�! BondedThruBu*NcWyServices