HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
1-s—T.I u t.I,u—A,
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 �D
(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 , 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 Owner Name(Please Print)
P operty caner Signature D e
STATE OF FLORIDA,COUNTY OFCIYI N
ACKNOWLEDGED BEFORE ME THIS DAY OF Nl l)lW ,20 '2,1
BY I`Itll l Cox^ W11l jn a_ WHO//rIS PERSONALLY KNOWN TO ME 0 OR WHO HAS
PRODUCED Fl. L l/V �p' �'S(o"-L�� AS IDENTIFICATION.
(�SIGNATURE OFF NOTARY PUBLIC TYPE OR PRINT NOTARY
"15�o l� 4 21 y COMMISSION NUMBER
:�iY TAMROUSE
€?°•�r�� NotaryPub'c- a{eof Florida
Commission#GG 959268
••.,,oF r;;. My Comm.Expires Jun 12,2024
Bonded through National Notary Assn.
SLCPDSD Revised 04/11/2011
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