HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 4624553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
(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.
5 5,�
Property Ow�neerrj Name (Please Print)
C1C5 lad
roperty Owner Signature Date
STATE OF FLORIDA, COUNTY OF 5�kiiti
ACKNOWLEDGED BEFORE ME THIS 2-24jp DAY OF 20iA
By- 'Ai l2f2' 7 WHO IS SONALLY KNOW O ME eOR WHO HAS
IT&Q 111044:01
/ SIGNATURE OF NOTARY PUBLIC
C& ZT7_1210 COMMISSION NUMBER
SLCPDSD Reviscd 04/11/2011
AS IDENTIFICATION.
A ` -w D
TYPE OR PRINT NOTARY
i►Wv °�e •.,
5� o
ARWEN D AD� )
Notary Public - State o Florida�
Commission # i� 272920
FA.��`'
"
My Comm. Expires Oct 31, 2022
Bonded through National Notary Assn.