HomeMy WebLinkAboutFilled Land Affidavit_•: _:-.::;;. ;, 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 ld#/Legal (Jescription/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development'Permit, BP Number
acknowledge
that as owner of the above described property, and in accordance I with Section
7.04.0l(D), St. Lucie County Land Development Code, I shall be responsible ft.ir 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 Coutlty 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.
5 .
Propertycaner Name (Please Print)
i
Property i�aature I:
Dati:
STATE OF FLORIDA, COUNTY OF,
ACKNOWLEDGED EIEFORE E THIS Z ('10 _ DAY OF V
1 20—=-1 BY��r
PRODUCED —WHO IS PERSONALLY KNOWN ME
OR WHO HAS
�11 —AS 1IDENTIFICATION
IC.NAQ� QIh�yy"`NfOH
S NATURE OF N FAR UBLIC
TYPE OR PRINT NOTARY
GGo 1 COMMISSION NUMBER
(SEAL)
1�H:
RICHARD DOUGLAS JOHNSON
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SLCPDSD Revised 04/11/2011 `;• fi �r
Nolary Public - SIBIe of Florida
Comm 55ior.pGG084921
My Comm. Expires Mar 20.2021
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