HomeMy WebLinkAboutFilled Land Affidavit PLANNING & 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,
17 h9 Nmek C bJ nJ &' le �� �
(l am l�
(Parcel Id#/Legal descriptiio
I h on/Address)
tIC5
for which ave 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), 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.
Property Owner Name(Please Print)
Property Owner Signature D to
STATE OF FLORIDA,COUNTY OF S lt (��
ACKNOWLEDGED BEFORE ME THIS (to DAY OF ,20 Q61
BY RdRe(-t- WHO ID�S PERSONALLY KNOWN TO ME 0 OR WHO HAS
PRODUCED 1 1 AS IDENTIFICATION.
S AIGN URE OF NOTAKff UBLIC TYPE OR PRINT NOTARY
4016
COMMISSION NUMBER ELLS
N VA U G H N
400e:State of Florida-Notary Public
ACommission # GG 270079
My Commission Expires
Oeteber 22 2A22
SLCPDSD Revised 04/11/201 I v _