HomeMy WebLinkAboutFilled Lands Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652 RECEIVED
(772)462-1553
FILLED LAND AFFIDAVIT msttie�� Dapartment
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I,the undersigned, am the owner of the following described property; `
(Parcel Id#/Legal description/Address) F;wcl Dela-a Ae-r1- .ezr_e / 7- 3r`/0`-/
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)7 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.
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Property/Owner Name(Please Print)
2Q*=_1 244& . -s=9-/
Prope Owner Signature Date
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STATE OF FLORIDA,COUNTY OF
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ACKNOWLEDGED BEFORE ME THIS _DAY OF 20��,
BY_�8 Lu LX!WHO IS PERSONALLY KNOWN TO ME ❑( )OR WHO HAS
PRODUCED o AS IDENTIFICATION.
44
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
KAREN S. NIELSEN
=o`P State of Florida-Notary Public
•_ Commission # GG 207484
My Cormission Expires
SLCPDSD Revised 04/11/2011 �� June 12, 2022
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