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,
(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 aby'0!5e#1 , 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 N e(Ple Case Print)
0 �� f RECEIVED
operty Owner Signature Dat
APR 3 0 1011
P•:rmitti.ng Department
STATE OF FLORIDA,COUNTY OF J i, L St. Lucie COu:'It/
ACKNOWLEDGED BEFORE ME THIS DAY OF 24Ff 120
BY G�11/C d Ig/IE��CJ WHO IS PERSONALLY KNOWN TOME(BI)OR WHO HAS
PRODU —L AS IDENTIFICATION.
6—C)'I'l�7/
GNATURE O OTARY PUBLIC TYPE OR PRIN OTARY
�6�Ya COMMISSION NUMBER
(SEAL)
Joseph Gomez
SLCPDSD Revised 04/11/2011 Commission#GG161404
• 'Q Expires:November 16,2021
Bonded thru Aaron Notary