HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
• Building & Code Regulations Division
2300 VIRGrMA AVENUE
FORT PIERCE, FL 3498M652'.
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned,am the owner of the following described property,
(Parcel Idi#/Legal descriptionyAdress)(04
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number
that as owner of the above described property, and irio accordance l with Section
7.04.01(D),,Si. Lucie County Land Development Code, I shall be responsible for assuring
adequate'drainage so that the immediate communit
I further acknowledge that in granting this permit for the mentLL NO be dof this property,
St. Lucie County is neither obliged nor- liable to provide for, or ma.intairt in an form
adequate drainage off my property which will not adversely affect the immediate
community.
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Property Owner Name (please in()
Property ignature
Date
STATE OF FLORIDA. COUNTY OF-45tLt`
ACKNOWLEDGED EIEFORE ME THIS —/—wA� �__ DAY OF YC.,�
B Y , 20__II_
�VHO 15 PERSONALLYKNOWN TO ME
PRODUCED (71OR WHO HAS
AS IDENTIFICATION
S NATURE -OF N rAR UBLIC
G&OSgg11) CUMMISSION NUMBER
SLCPDSD Revised 04/11/201 1
TYPE OR PRINT NOTARY
(SEAL)
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RICHAP,D DOUGLAS JOHNSON
NolaryPublic —Sidle of Florida
Cam:n451or. P GG 084821
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My Comm Expires Mar 20. 2021
Bunded Imouyh Na1109dl Plalify Assn.