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,
(Parcel 10/1-egal description ddress)
tIy
for which I have applied to St. Lucie County for a Final Developmetl.t Permit. In
accepting this Final Development Permit, BP Number
that as owner of the above described property, and in accordance I witlh Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible flit assuring
adequate drainage so that the immediate community g
I further acknowledge that in granting this permit or the mentdofthis prversely operty,
erty.
St. Lucie COL111ty 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.
R6CXM S
Property O%vner Name (Please Print)
PProer
h' ignaturz —�
Date
STATE OF FLORIDA, COUNTY OF LAIL•
ACKNOWLEDGED EIEFORE ME THIS I I
BY W 6 a)e-rv�-�-- DAY OF Mkr L \ 20 z�
� IYHO PRODUCED IS PERSONALLY KNOWN TO ME C�O OR WHOJ
HAS
AS IDENTIFICATION
S NATURE OF N rAR UBLIC �IC.�Aer� q1� VVIhN IOH
TYPE OR PRINT NOTARY\1
D 4 COMMISSION NUMBER
(SEAL)
SLCPDSD Revised04/I I/2011 • I�
RICHAP,DDOUGLASJOHNSON
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Com.n,ssior.0 GG 084821
My Comm Expires Mar 20.2021
Bunded lNq,yh N,111001101iry Aim.