HomeMy WebLinkAboutFilled Land AffidavitPLANNING & 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/
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.
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Property Owner Na ease Pri )
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Property Owne ture Date
STA E OF FLORIDA, COUNTY OF�
ACKNOWLEDGED BEFORE MEETTHIS
� I�p DAY OF•_'9,e, aA 120 C;
BY �VY� L� 1 J • I YrI t)ri WHO I3 ERSONALLY KNOWN TO ME LEIj OR WHO HAS
PRODUCED AS IDENTIFICATION.
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SIGNATURE OF NOTARY LIC TYP R PRINT NOTARY IJ
COMMISSION NUMBER
SLCPDSD Revised 04/1 1/2011
(SEAL) SI
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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,
�Sie"� _ 16' 1`1 AS�i tc.- cyAy
(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 Owner N (•P1 Print)
Z1/ 7%Z/
Date
S
TATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 120 4:;V' ,
BY Yin 'WHO IS PERSONALLY KNOWN TO ME LEI) OR WHO HAS
PRODUCED
SIGNATURE OF NOTA Y PUBLIC TYPF40R PRINT NOTARY
COMMISSION NUMBER
(SEAL)
AS IDENTIFICATION.
SLCPDSD Revised 04/11/2011j
_ AUDREYB.HUMPHREY tea
•�oSYP�BG AUDREY B. HUMPHREY -'*? MY COMMISSION # GG 3008 i 7 r
MY COMMISSION # GG 360817 L�
�. �' EXPIRES: March 6, 2.023 I
9FQ Y EXPIRES: "
of Fro , March G, 2023 ' 3onded 7hru Notary Public Undervriter.
Bonded Thru Notary Public Unden=