HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT P[ERCL•'. PL 34992-5652
(772) 462-15�3
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
_33,Q ;7-'2o/-005e6 -6W - 9/8S�9 l3F
(Parcel Id#/Legal description/ ddress)
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.
-e-6 ey S" e A ` a K
Property Own r Name (Please Print)
;A 7-13--a/
Property 00 er Signature Date
SPATE OF FLORIDA. COUNTY OF TI/7
ACKNOWLEDGED 131 ORF'. ME THIS A3 Y OF 20�,
BY r171Zk WHO IS PERSONALL
Y KNOWN ' TO ME ( }OR WFIO HAS
PRODUCED ,��{ •��5a - 5"a0• 5 .wY7 ' D AS IDENTIFICATION.
SIGNATUS UYe�K+O NOTA Y PUBLIC
0?SO/ 9OMMISSION NUMBER
SLCPDSD Revised 04/11/2011
TYPE OR PRINT NOTARY
(SEAL)
,yaYft Ngtzry Pudic State of Florida
Lori A Maxlsy
My Commission GG 280148
?FCC M1 Expires 1112812U22
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