HomeMy WebLinkAboutFilled Land Affidavitj
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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
o Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
T, the undersigned, am the owner of the following described property,
1301-614-0149-000-8 Lakewood park unit 12, block 1,62 Lot 15
(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.
Pr er caner Na ease Print)
Z Z
Pr erty Owner Signature Dat
STATE OF FLORIDA, COUNTY OFSak
ACKNOw" DGED BEFORE METHIS �_ DAY OF 21 ,
BY � WHO IS PERSONALLY KNOWN TO ME (�R WHO HAS
PRODUCED AS IDENTIFICATION.
QUATO �'F�N.XTARY PUBLIC TYPE OR PRINT NOTARY
1 1 I COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011 MEE
tate of Florida"
GG 177104
022