HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGIMA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
(Parcel IM/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Fin ai.,Development Permit, BP Number , I acknowledge
that as ownP. of tho ebovc described property, and .in acc-ord-,.nce with Se lion
7.04.0 t(D), St. Lucie County Land Development Code, I steali 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.
ro�perty Owner ; taa,,� (Ple<ue Print)
�
a'� r � a z G y Z
Property Owner Signature D e !t
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED
IBEFORE METHIS 0 - DAYOF Ja.(, 20 g
BY ��% • �/�C lbj A WHO IS PERSONALLY I' OWNTO ME (EJOR WHO HAS
PRODUCED
S�' NA'`i` OF NOTARY PUBLIC
COMMISSION NUMBER
SLCPDSD Revised 04/1 Inn I I
AS IDENTIFICATION.
":_'/C%''Ati:, d <� al-@/i c-
TYPE OR PRINT NOTARY
(SEAL)
JOANNEWILLS
.; *_ Commission# GG 272813
Expirea Februar,120, 2023
Bonded Thru7roy Fain In,uranca 800.386.70?8