HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & Uri EI.:t➢P>ll V"1' SERVICES DEPARTMENT
(11772) 462-15, 5.1
FILLED LAND AFFIDAVIT
1,the unders"'I'llIgned, am the owner of tlie f-bJ1o,wi`ng described , proapetrty,
10511 Oak Bridge CT
(Parcel 10/Legal deserliption/Addresss)
ad qLtate drainage
1
comm"'unity.
�J, r
. ...... . . ........
off my property which wil"11.1 not adver,ly affcct ths-ct, H*=,ediixate
flroperty OxNuner Name (1, ease Vrint)
Propej,,,ty Ow-ner Signature
`-TA`,TE OF FLORMA, 011)UNTY 0
S
A
'te
Date
ACKNOWLEDGED 13'EF0R[1'11'4'MF T111" D A Y 0 F
B Y W110 IS PE.. NAKNOWN T011"
PRODUCED
ARY PIA-311C
NN"13MBER,
M,
El
SLCPDS,D Re,;Iv�ised 041,,`11121,011
M
a
TYPEOR FIRINN'TNOTARY
(SEAL)
110
� ORWHO H,,,AS
AS IDENTIFICATION.