HomeMy WebLinkAboutFilled Land Holiday Out lot 481_000403PERP.4IT 2102-0463
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 the following described property,
4511-502-0029-000-1 @ 10725 S Ocean Dr Lot 481 Jensen Beach FL 34957
(Parcel Id#/Legal description/Address)
for which I have applied to -St. Lucie County for a Final Development acknowledge
t. I e
accepting this Final Development Permit, BP Number 2 10 2- 0 4 6 3 g
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 1\i OT 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.
Robert Hoffman
P e Name (P ase
Proper wner Signat Date .
STATE OF FLORIDA, COUNTY OF /
ACKI WLEDGED BEFORE MBE THIS `f DAY OF tr 120 v'
BY 76OL V-� WHO S PERSONALLY KNOWN ME C[:]) OR WHO HAS
PR CED , I AS IDENTIFICATION.
N
SIGNATURE OF NOTARY PUBLI TYPE OR PRINT NOTARY
COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
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