HomeMy WebLinkAboutfilled lands affidavit PLANNING& DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652(772)462-1553
FILLED LAND AFFIDAVIT lz7j
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.
c _
Property O er Name(PIE e Print
z�z_)
Property N&Signature 61 Da e
STATE OF FLORIDA,COUNTY OF U kf
ACKNOWLEDGED BEFO ME THIS DAY OF MM _, ,20a i
BY WHO IS PERSONALLY KNOWN TO ME LDj OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBL TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
KAREN S. NIELSEN
State of Florida-Notary Public
Commission #GG 207484
SLCPDSD Revised 04/l 1/2011 9 0
' My Commission Expires
June 12, 2022