HomeMy WebLinkAboutFilled Land AffidavitPLANNING & 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,
6 37°l I— 13 lJ :y 6 6 a
(Parcel Idly/Legal de cription/Address) n t
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number
that as owner of the above described property, and in accordance I w tlh Sectdion
ge
7.04.01(D), St. Lucie County Land I)evelOpment Code, I shall be responsible ft.i
adequate drainage so that the immediate community yVIL r assuring
L NpT 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 an
adequate drainage Off my property which will not adversely affect ty form,
he immediate
community.
�rJdeA
Property Qv Name (PleasePrint)
Property ignature — 3 °� !'
Date —
STATE OF FLORIDA. COUNTY OF 15� 4+-�_
ACKNOWLEDGED EIEFORE ME THIS %
DAY OF Q/c20
BY �� WHO IS PERSONALLY KNOWN TO ME
PRODUCED t� OR WHO FIRS
� \AS IDENTIFICATION
S NATURE OF N rAR UBLIC
I YPE OR PRINT NOTARY
GGogygat Ct�MMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/1 I/20I 1
;: s p; p •. RICHARD DOUGLAS JOHNSON
"• NolarY PubhC - SIeIe of Ronda
��•: = ComnssiorpGG484821
My Comm Expires Mar 20, 2021
BunCeE lNough NaUon,ll Nalary Assn.