HomeMy WebLinkAbout7 - Filled Land AffidavitPLANNING &DEVELOPMENT SERVICES DEPARTMENT
IT Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 4624553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
4201-113-0001-020-9/4201-113-0001-010-6 9675 Range Line Road, Port St. Lucie FL, 34987
(Parcel Id#/Legal description/Address)
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), 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)
PIoperty Owner Signature
STATE OF FLORIDA, COUNTY OF
Dat
ACKNOWLED1G"` ,E_D BEF1ORE ME THIS �� DAY OF /-AP�.• ` �
BY Keg Do m� WHO IS PERSONALLY KNOWN TO ME (✓) OR WHO HAS
PRODUCED
�Q
10
SIGNA//��TURE OF �2TARY PUBLIC
n 21 "I ftCOMMISSION NUMBER
SLCPDSD Revised 04/11/201 I
AS IDENTIFICATION.
�✓LIO 1�t I �C.
TYPE OR PRINT NOTARY
Cindy M. Rine
o� NOTARY PUBLIC
(SEAL) c . �'—STATE OF FLORIDd1
Comm# GG969922
Expires 3/27/2024