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
1, the undersigned, am the owner of the following described property,
60-/V/- a'zzleC, e_- t7-/ � �s
(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-,-gn 21 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)
926
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BErORE ME THIS ` , - BAY OF
�e/ice Tom►'' `'1�'� , 20—
BY I� %PV1 Cl V �i ��/-S0/1 WHO IS PERSONALLY KNOWN TO ME — OR WHO HAS
SIGNATURE OF'NOTARY PUBLIC
61!� 111%jr)F MMISSION NUMBER
AS IDENTIFICATION.
n 0-1 AV2i l t
TYPE OR PRINT NOTARY
(SEAL)
State of Florida Acknowledgement Notary Certificate
STATE OF FLORIDA
COUNTY OF St Lucie
On Sept 17 2021, before me, Shannon Arill, a notary public, personally appeared by physical presence, karen
Gunderson who proved to me on the basis of satisfactory evidence to be the persons) whose name(s) is/are
subscribed to the attached Filled Land Affidavit [name of document] instrument and acknowledged to me that
that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s) or entity upon behalf of which the person(s) acted executed the
instrument. I certify under PENALTY OF PERJURY under the laws of the State. listed above that the foregoing
paragraph is true and correct. WITNESS my hand and official seal.
Personally known OR
Produced identification xx Type of identification produced:
(Signature of notary public)
My commission expires: Feb 20, 2022
4AP&
RILL
ENOta:rYPU�:bl!�,c:e of FloridaG 172479eb. 20, 2022
`Official Seal
05-74-0433NSB 02-2020