HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
' 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 followiing�desccrrIib d grog` itpAV&
(Parcel Id#/Legal
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 Na a (Please Pnnt)
Prop .. et Signature Dpe
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS � � DAY OF 00 , 20
BY pY'P_L/I (�� 1 WHO IS PERSONALLY KNOWN TO ME (_) OR WHO HAS
PRODUCED
p�}�SIGEE NATUROFF NOTARY PUBLIC
1 V 1. � 02q ]l`o COMM)SSION NUMBER
SLCPDSD Rcviscd 0411 1/2011
AS IDENTIFICATION.
1
TYPE OR PRINT NOTARY
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