HomeMy WebLinkAboutFilled Land Affidavit�JL,E �OGy ST. LUCIE COUNTY
BUILDING & ZONING
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
A�OR1�P • 561 462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property:
f9/�-c& 3_ -ZyIC1(%,e%id f r�s ///> % ��9�e L�
' (Tax ID/Legal description/Address) `
for which I have applied to St. Lucie County fof a Final Development Permit. In accepting
this Final Development Permit, BP Number �,51j1 r d,6al , 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 Name Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 20_,
BY
SIGNATURE OF NOTARY
IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
IDENTIFICATION.
TYPE OR PRINT NAME OF NOTARY
(SEAL)
NOTARY PUBLIC TITLE COMMISSION NUMBER