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ST. LUCIE COUNTY
BUILDING & ZONING
2300 VIRGINIA AVENUE
FORT PIERCE, FL.34982-5652
772-462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am� the owner of the following de_00scribed property:
(Tax ID/Legal descripdoff��
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 Namq Property Owner Signature Date
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SIGNATURE OF NOTARY
NOTARY PUBUC TITLE
DAY OF 20�
HO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
IDENTIFICATION.
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TYPE OR PRINT NAME OF NOTARY
65'170--�cf (SEAL.)
OMMISSION NUMBER
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