HomeMy WebLinkAboutFilled Land Affidavit�JL�� COGy ST. LUCIE COUNTY
BUILDING & ZONING
r 2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
F�OR10p 5611462-15M
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property:
32,1( 101 0 o' E1 D®()% S" .
(Tax 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.
1/yy" ly-i ilk CGI NyVt.—
Property Owner Name
STATE OF FLORIDA. COUNTY OF .ST - L.,
Property Owner Signature Date
-ACKNOWLEDGED'BEFORE ME THIS 10 DAY OF L±Rni I .200
BY WHO IS PQSONALLY KNOWN T ME OR WHO HAS PRODUCED
SIGNATURE OF NOTARY
NOTARY PUBLIC TITLE
IDENTIFICATION.
TYPE OR PRINT NAME OF NOTARY
(SEAL)
Ci�LI,IpO R
ate•}*' Eq*u 4IH3/2M8
BWAJ9d VVIA (800)432-4254
o'``�P Florida NotaryAsan., Inc
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