HomeMy WebLinkAboutFilled Land Affidavit i
RECEI`.'^D S49 7_07 i
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,
(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.
TDA- 4c
Pr5r'Y-
Owner Name a Print) J
operty Owner signat&e Date
STATE OF FLORIDA, COUNTY OF -e /-
ACKNOWLEDGED BEFORE ME THIS / DAY OF ��?�� 20 l
BY !i/(�� T yl�— WHO IS PERSONALLY KNOWN TO ME ( ) OR
WHO HAS PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
Orlando Rivera
Notary Publia
State of Florida
n o ExpUes
SLCPDSD Revised 04/11/2011 NS► � xpl
5,2020
Comffftsion Nw GG 36483
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