HomeMy WebLinkAboutFilled Land Affidavit I
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
o 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
��J -ems
FILLED LAND AFFIDAVIT 70�"
I,the undersigned, am the owner of the following described property,
20 Nettles Boulevard Jensen Beach, FL 34957/4502-501-0206-000-5
(Parcel Id#/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.
Property wner Name I ase int)
iroperty Owner Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF �� Yj ,20
BY `�� l-5� 1 Y�17 WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUCED AS IDENTIFICATION.
a—/,Y,.4'� 'Iege5a �(wl)ez �t
GNAT y ARY PUBLIC TYPE OR PRINT NOTARY
U�COMMISSION NUMBER
(SEAL)
TERESA L @CAMERf14 yl
SLCPDSD Revised 04/I 1/2011A&
MY COMMISSION#FF227168
'•'. ',EXPIRES May 05.2019
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