HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
NNW 2300 VIRGINLA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the, owner of the following described property,
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(Parcel Idk/Legal de c iption/Address)
for which: I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development' Permit, u Number �,/ that as owner of the above described property, and in accordance I `aclalowledge
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible fcth Section
adequate drainage so that the immediate communit r assuring
I. further acknowledge that in granting this permit for the devebe lopment of ily affected.
St. Lucie County is neither obliged nor liable to provide For, or maintain in an
property,
adequate drainage off m Property p y form,
commun.idy.
y P p } which will not adversely affect the immediate
Properly Owner NamF
(Please Print)'
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Property ignature
Datc
STATE OF FLORIDA. COUNTY OF--C& LU `
ACKNOWLEDGED EIEFORE ME TH S
__ DAY OF _A&I,
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PR WHO IS PERSONALLY KNOWN TO ME
ODUCED OR WHO 1-(AS
1 f AS 1IDENTIFICATION
4NATUREOFN rAR UBLIC �1LNAQr� �IEV JON
TYPE OR PRINT NOTARY\1
O 4 I: CI)IMMISSION NUMBER
SLCPDSD Revised 04/1 1/2011
(SEAL)
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RICHARD DOUGLAS JOHNSON
'NolaryPublic - Sidle of Florida
COMM-55,or. M GG 084821
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My CaRrti Expires Mar 20. 2021
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