HomeMy WebLinkAboutFilled Land Affidavit '1
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
COUNTY 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 I0/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,
Lucie t is neither obliged nor liable to provide for or maintain In an form
St L I County g p Y
adequate drainage off my property which will not adversely affect the immediate
community.
VL L lS —
Prope er Name(Please Print)
—a/,-7)-c>[
r erty Owner Signature Dat
STATE OF FLORIDA,COUNTY OF ic
�.
ACKNOWLEDGED BEFREE{ME THIS DAY OF lJ�/�✓I 120
BY ``"'`M,'U� v WHO IS PERSONALLY KNOWN TO ME 0 OR WHO HAS
PRODUCED f/ ICJ AS IDENTIFICATION.
e(
V SIGNATURE-0F N T PUBLIC TYPE OR PRINT NOTARY
C7wL) / OMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/I1/2011 ELLEN VAUGHN
State of Florida-Notary Public
Commission# GG 270079
74` My Commission Expires
Oetober 22