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 following described property,
3a ► s - 8o I - 001s-1)-Ocy a
(Parcel Id#/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.
Property Owner Name (Please Print)
3/J9
Pr erty Owner Signature Date
STATE OF FLORIDA, COUNTY OF -ST t GUG Ili -
ACKNOWLEDGED BEFORE ME THIS g R 4 - DAY OF / / I(/LlfCA.— 120 obi I ,
BY E I ZO, �y��yy�1 /� 1(2 /'1-jUd0_ WHO IS PERSONALLY KNOWN TO ME 12) OR WHO HAS
PRODUCED 1'"li l C AS IDENTIFICATION.
/SIG U�RyE OFOyNOTARY PUBLIC TYP R PRINT NOTARY
�+LCI % C11 l COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
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