HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
` Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 3498Z-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned: am the owner of the following described property,
'(Parcel Id#/Legal description/Address)G-�—
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 .o:f the above described property, I acknowledge
adequ 1(D), St. of
County Land Development Codealdshall be responsibleith for Section
adequate draassuring
inage so that the immediate community WIL-- L NET hp adversely affected
I further acknowledge that in granting this permit for the..de.velopment 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 n
C o m mU n.i.t y. ot adversely affect the immediate
l t oLm `l
Property Owner Name ( lease Print)
� L
Property ;gWn;a re _
Date
STATE OF FLOPJDA. COUNTY OF
ACKNOWLEDGED IIEFORE
������ Q�,, ��� � ME THIS �__ DAY OF
B Y
'' WHO IS PERSONALLY KNOWN TO ME
W (_ j OR WHO HAS PRODUCED
AS IDENTIFICATION
4NA REOF N rAR �1CL�Ak�
UBLIC
TYPE OR PRfNT NOTARY
GCr.D— 5 �L COMWSSION NUMBER
SLCPDSD Revised 04/11/2011
(SEAL)
; ��N:>;q,•
RICHARD000GLAS'IOH]Aj�n,
Nolary Public - SIM of Fl
C6mrl,ssioc p GG 0848
My Carrm Expires Ma; 20.
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Buneee ImayA Ndlmaal Nolary