HomeMy WebLinkAboutFilled Land Affidavit-
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 I /IRGINIA AVENUE
FORT PIERCE, FL 34982-5652
I(772) 462-1553
FILLED ILAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
MO all&y#' r'r 'Q, _-3[
(Parcel Id#/Legal description/Address)
for which I have applied to St.. Lu
accepting this Final Development Pe
that as owner of- the above descr
7.04.01(D), St. Lucie County Land Df
adequate drainage so that the immedi
I further acknowledge that in grantin
St. Lucie County is neither obliged 1
adequate drainage off my property.
community.
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Property Owner Name (Please Print)
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Owner Signature
'13 /9 - A3 -2 - oe 00V-66o-R
ie County for a Final Development Permit. In.
mit, BP Number , I acknowledge
red property, and in accordance with Section
/elopment Code, I shall be responsible for assuring
to community WILL NOT be adversely affected.
this permit for the development of -this property,
)r liable to provide for, or maintain in any form,
which will not adversely affect the immediate
Date
STATE OF FLORIDA, COUNTY OF �� GU�/•
ACKNOWLEDGED BEFORE ME THIS DAY OF 0� • 20 d ,
BY g,�.� Q? O IS PERSON LY KNOWN TO (ElOR WHO HAS
PRO ED AS IDENTIFICATION.
DVV
SIGNATURE OF NOT PUBLIC E OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
SI;CPDSD Revised 04/11/2011
6QZ Al10REY g. NUMPHREY
MYCOMMISa%N#GGSW817
EXPIRES: � bft 6 W9,
•. °Q Bonded Thru *18 12UI c Unde►Mbm