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HomeMy WebLinkAboutFilled Land Affidavit PLANNING&DEVELOPMENT SERVICES DEPARTMENT iCOUNTY 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/Add ess) for which I have applied to St. Lucie County for a Finial Development Permit. In accepting this Final Development Permit, BP Number 6 S'`7 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) 2121 perry Owner Signature Date STATE OF FLORIDA,COUNTY OF ACKNOWLEDGED 13EFORE ME THIS DAY OF 20 BY WHO IS PERSONALLY KNOWN TO ME(EI)OR WHO HAS PRODUCED AS IDENTIFICATION- 'E°�r SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY COMMISSION NUMBER (SEAL) SLCPDSD Revised 04111P011 JUN 0 9 2021 St.Lucie County Permitting FLORIDA JURAT FS 117.05(13) State of Florida County of ST• LU(-) Sworn to(or affirmed)and subscribed before me by means of sical Presence, —OR— ❑Online Notarization, this CT dayof TO C)UD_I,by Day Month Year JOSHUASODAS 'a�• �:`. Notary Public'State of Florida Commission#GG 977662 m of P so wearing or Affirming Apr i 2,2024 OF fV. µy Comm.Expire S gnature of fttdry Public—State of Florida Name of Notary Typed, Printed or Stamped ❑Personally Known roduced Identification Type of Identification Produced:'�� T�� Place Notary Seal Stamp Above �'Ft o�_)• OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: ACI�U�. ��yL(-�� Nr ����i�s 1C)6;P fT Document Date: `a Number of Pages: Signer(s)Other Than Named Above: Uw a� ��— 3- ©2020 National Notary Association M1304-10(11/20)