HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
' Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1.553
FILLED LAND AFFIDAVIT
I; the undersigned, am the owner of the following described property,
53-7 d Addre 13 p I Tao
(Parcel Ida/Legal descri lion/Address) I4
for which I have applied to St. Lucie County for a Final Developmen.t Permit. In
accepting this Final Development Permit, BP Number
ack
that as owner of the above described property, and in accordance I with Sectdion
7.04.01(D), St. Lucie County Land Development Code, I shall be respoLL NO be a nsible for assuring
adequate drainage so that the immediate communit
I further acknowledge that in granting this permit for [he mentdofthi1s rofeet d.
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 Qwner 11jame (please Print)
O Z
Property 'ignature _
Date
STATE OF FLORIDA. COUNTY OF
ACKNOWLEDGED 8EFORE ME THIS 6
�__ DAY OF
B Y
�WHO IS PERSONALLY KNOWN TO ME OR WHO FIAS
PRODUCED WHO
I f\AS 'IDENTIFICATION
4NA REOFN FAR U13LIC ��C"hAeC alb �iU�NJpN
TYPE OR PRINT NOTARY
G-6-C'84Bal Ct)MMISSION NUMBER
(SEAL)
;; •tipii�o�A••, RICHAP,000UGLAS JOHNSON
SLCPDSD Revised04/11/2011
Nolary Public - SIJIe of FlonCa
�•: '= Comm.5sordGG084821
My Comm Eapites Mar 20.2021
°• BundeditUMhNaboaalNolaryAssn.