HomeMy WebLinkAboutFilled Land Affidavit PLANNING& DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
COLINTY
• A 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
i
I,the undersigned, am the owner of the following described property,
2'-//)J 49R n7'7 i' �5
(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.
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Pr6perty Owner Name(Please Print
Proper weer Sign e Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS� _DAYeL
BY�/-d::1 I�WHO Is PLY KNOWN TO ME CEI)OR WHO HAS
PRODUCED 1'9 " dC AS IDENTIFICATION.
SIGNATIORE OF NOT T
PUBLIC TY E R PRINT NOTARY
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/1 1/2011 ;=o •Ogi�; AUDREY&HUMPHREY
#: *_ MY COMMISSION#GG 3008V
EXPIRES:March 6,2023
FP„F:°P Bonded Thru NolarvP,,hf c UndenYriters