HomeMy WebLinkAboutFilled Lands Affidavit PLAL?4NJNG & DEVELOPMENT SERVICES DEPARTMENT
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F L 0 R 1 0 -A 2300 VIRGINIA AVENUE
FL 34982m5652FORT PIERCE,
(772) 462m 15 53
FILLED LAND AFFIDAVIT
1I, the undersigned, am the owner of the following described property, i
3402110=609m0003-00OM3 / INDIAN RIVER ESTATES- UNIT 08w LK 19 LOT 25 / 59
(Parcel Id#/Ixgal description/Address)
fo r which I have applied to St. Lucie County for a Final Development PULmit . In k
accepting this Final Development Pei-, nut, BP Number I acknowledge
that as owner of the above described property, and in accordance with Section
7. 04. 01 (D), StLuci
e County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WML NOT l�ililll)e adversely affected.
I further acknowledge that in grant ing this pe -Im t for the development of this property,
St_ Luc i e County i s neither obliged nor liable to provide for, or maintain in any fol 114
adequate draInage off my prop ...,erty which will not adversely affect the immediate
comaunity.
Pr er-ty Owner Name (Plea'w se Print)
SL .
Pr Owner Si afore Date
STATE OF .FWRIDA-9 COUNTY OF
ACKNOWLEDGED BEFORE MLE THIS .22 DAY OF F�,OdA �G f/ . 20MZ/
BY WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PROD U C ED �L69A 6G e 1 � O AS IDENTIFICATION.
0000-0
rA0000'
S TUR.E OF NOTARY PUBLIC TYPE OR PRJFNT NOTARY
C-G ofo� y2 COMMISSION NUMB III Oil JASON B.. CLARK SR.
W COMMISSION #GG
D�IRES: MAR08, 2021 (SEAL.)
Bonded U 1 st State Insurance
SLCMSD Revised 04/ 11 /2011