HomeMy WebLinkAboutFILLED LANDPLANNING & 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 the following described property,
H4CI
(Parcel
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)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF _� l"
ACKNOWLEDGED BEFORE ME THIS �_ DAY OF 120
BY — L - WHO IS PERSONALLY KNOWN TO ME �
rOR WHO HAS
PR ED AS IDENTIFICATION.
4 SIG OF NOTARY PUBLI T E OR PRINT NOTARY
COMMISSION NUMBER
EllQf.
t Christine
.SLAM of Flords
hris4ine A. Marsh
Commiss+an HH 028706pren 08102l2024
SLCPDSD Revised 04/11/2011