HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
' Building & Code Regulations Division
....NNW 2300 VIRGWLX AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
(Parcel Idk/Legal description/Mdress)
for which I have applied to St. Lucie County for a Final Developmerl.t Permit. In
accepting this Final Development Permit, BP Number
acnowlege
that as owner of the above described property, and in accordance I w tlh Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community
I further acknowledge that in granting this permit for the developmentLL NO be ofthis ao(eerty.
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 Owner Name (Please Print)
Property
igrlature ---
Date
STATE OF FLORTDA, COUNTY OF -Sk" LA,( • 'L-
ACKNOWLEDGED EIEFORE ME THIS I
By pTo�0.vyls �_— DAY OF M0.r L \ 20— ZI
IS PERSONALLY KNOWN TO ME (�OR
PRODUCED WHO HAS
`AS1IDENTIFICATION
S NATURE OF N rAR UBLIC �IC.�AQ� -Qltii VO"�N
TYPE OR PRINT NU I ARYv J ON
4 COMMISSION NUT11BER
(SEAL)
RICHAP,000UGLASJOHNSON
SLCPDSD Revised 04/11/2011
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