HomeMy WebLinkAboutFilled Land Affidavit s �,r:.�.. PLANNING &DEVELOPMENT SERVICES DEPARTMENT
77
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,
L.02 (Cl 0-0-7 Ct- WO 1-2,
(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 OL 11jb-0 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.
Property O r ".a lease Print)
e�l' I aA
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS oCh. DAY OF c/� 2
�`\V0�,
BY a\0Q. Qas � WHO IS PERSONALLY I NO TO ME JE-1 OR WHO HAS
PRODUCED iV/ a AS IDENTIFICATION.
41kk&:�
SIGNATURE OF N ARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011 l0
1AR
Notary Public
State of Florida
Commis HH025672
A ® Expires 7/30/2024