HomeMy WebLinkAboutFILLED LANDS AFFIDAVIT - 3 QUINTANA ROO LANE ST. LUCEE COUNTY
BUILDING & ZONING
2300 VIRGINIA AVENUE
t8 FORT PIERCE,FL 34982-5652
=-462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property:
3427-111-0002-000/5
CTax ID/agal 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 Property Owner Signature Date
STATE OF FLORIDA.COUNTY OF "C!E
ACKN,OOWLEDG�ED B/EFORE ME THIS t��ygDAY OF Tu c y 20�/
BY / �7g// z C�� Cyr �y'—VIFtO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION. �1
I�n,¢o?HY Amp-) [7ASK�.J
SIGNATURE OF N ARY TYPE OR PRINT NAME OF NOTARY
(SEAL)
NOTARY PUBLIC TITLE COMMISSION NUMBER
DOROTWA"M'BASK;N
U—�
MY CO?AASSiON 4 HH 045443
EXPIRES:October 2,2024
Bonded Thm N:aPubfic'Jntlerwriters
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