HomeMy WebLinkAboutFilled Lands 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,
4 56 a 561 i 45� 0005
(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.
C
Property 04ner Name(Please Pr' t)
6 anus,
Property er Signature Date
STATE OF FLORIDA,COUNTY Oa4..4��t
ACKNOWLEDGED BEFORE ME THIS DAYOF_Sy4eb201 ,
BY HO IS PERSONALLY KNOWN TO ME(_)OR WHO HAS
PRODUCED AS IyDEE'NTIFICATION_
At
SIGNATURIE 1VOTARYPUBLIC TYPE OR PRINT NOT RY
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011 "' p�pRE'IgION EE 59
a•'.e .: M,I COMMISS arch 6 2015
p'1_.: ;i EXpIP Not ry public UndeTMn�ers
`=D; �' 8ondedShN