HomeMy WebLinkAboutFilled Land AffidavitlollPLAN ZING & DEVELOPMENT SERVICES DEPARTMENT
• Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-I553
FILLED LAND AFFIDAVIT
I, the undersigned, -am the owner of the following described property,
id 6g, aA.
(Parcel Id#/Legal description/Address)
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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.
W. Bryan Adams
Owner Name Please Print)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF St Lucie
ACKNOWLEDGED BEFORE ME THIS DAY OF 20�
BY W. Bryan Adams
_WHO IS PERSONALLY KNOWN TO ME LED) OR WHO HAS
PRODUCED
AS IDENTIFICATION.
�L ' ► W UAJ Hannah Moore
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
017099
SLCPDSD Revised 04/11/2011
COMMISSION NUMBER
(SEAL)
Notary Public Slate o[ Florida
Hannah E Moore
My COMMISSM
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HH 017099
Expires 07/01/2024