HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
COUNTY '&
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)4624553
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
-,Z CDO /a
(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 , 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 orer Nam (Ple Print)
S i7 a
Property 6m;iei Siihature Date
STATE OF FLORIDA,COUNTY OF. elt
ACKNOWLEDGED BEFORE ME THIS DAY OF fnlzl A 120
BY WHO IS PERSONALLY KNOWN TO ME[ j OR WHO HAS
PRODUCED L AS IDENTIFICATION.
V)y4�6 T
SIGNATURE OF NOT MY PUBLIC TYPE OR PRINT NOTAR
� t) �C_OMMISSION NUMBER
(SEAL)
O.�pNY PUeii ELL EN
N VAUGHN
r_ :State of Florida-Notary Public
SLCPDSD Revised04/11/2011 9 0* Commission # GG 270079
My Commission Expires
October 22, 2022