HomeMy WebLinkAboutFilled Land AffidavitTG & 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
for which I have a
accepting this Final
that as owner of
7.04.01(D), St. Lucie
adequate drainage s�
I further acknowled
St. Lucie County is
adequate drainage
community.
Address)
plied to St. Lucie County for a Final Development Permit. In
development Permit; BP Number —_0,P 31 acknowledge
Ze above described property, and in accordance with Section
County Land Development Code,J shall be responsible for assuring
that the immediate community WILL NOT be adversely affected.
that in granting this permit for the development of this property,
wither obliged nor liable to provide for, or maintain in any form,
ff my property which will not adversely affect the immediate
x �/i1 /}r.GGJ D1+�'t t rt/
Property Owner Name (Please Print)
perty Owner Signature Date
STATE OF FLORIDA, COUN Y OF
ACKNOWLEDGED BEFORE ME THIS DAY OF y 20
By A-4� yy�`j7'�—� WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODU D AS IDENTIFICATION.
SIGNA URE OF NOTARY PUBLIC � `.'• °"'0�•'
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Expires April26, 2021
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SLCPDSD Revised 04/11/2011