HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENtIF
FORT PIERCE, FL 34482-5652
(772)462-15?3
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
Z913.5017.001?91-aea :g 10&eWa q 1011;e5 W7 ,?tw DAP
(Parcel ld#/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.
- � X1, .-5&/ 777Y
Property Owner Name {Pl7:4--
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OFTI/12
ACKNOWLEDGED BEFOREMEHI1S!=??.f DAY OF , 20��,
BY Z1%?1�HO IS PERSONALLY KNOWN TO ME (Ej;Y-CfR WHO HAS
PRODUCED � �3Q • J5�/' 5 /pQ A5 IDENTIFICATION.
SIGNATtAF OF//NOTARY PUBLIC I ) PI=_ 0R PRINT NOTARY
�o(���7LJ('()MM1SS10� NUMBER
(SEAL)
r"Ar �:rd_ Notary Public 51ma & FIxida
Lari A Moxl�y
My Commies on GG 280148
SLCPDSD Revised 04/11i2011 �'ra„�d� ExPires 1112e3/2022