HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 RECEIVED
FILLED LAND AFFIDAVIT JAN 1 2 2921
Permitting Department
St. Lucie County
I, the undersigned, am the owner of the following described property,
l no '0 n �5 ' L *a-i e
(Parcel I0/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. "
t u 0-0 ►+V) m i r- Q
Property Owfier Name (Please Print)
/rroperty 96ner Signature
STATE OF FLORIDA, COUNTY OF
Date
ACKNOWLEDGED BEFORE ME THIS `a" DAY OF .i 200,
BYst { 1 W om, n,A \ w WHO IS PERSONALLY KNOWN TO ME l0 OR WHO HAS
PRODTTCF.D_ _ �+ �y AS IDENTIFICATION.
SIGNATURE OF NOTAR UBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
KAREN S. NIELSEN (SEAL)
`47`HY PVB �i
;State of Florida Notary Public
=• •_ Commission # GG 207484
9. My Commission Expires
/01i1�O`June 12, 2022
SLCPDSD Revised 04/11/201
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