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,
)V'16
(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,
y� 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 O<vner Name (Please Print)
Property Aner Signature Date
J ,,QQ 11
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _ DAY OF SAgk 11 kV— 120
BY � 2 Y, V,9 V _ R.Cfe `s f A WHO IS PERSONALLY KNOWN TO ME (� OR WHO HAS
PRODUCED AS IDENTIFICATION.
SI ATUR OF N01 ARY PUBLIC T PE OR P * Y Fv
, TERESA PONCE DE LEON RODRIGUEZ
COMMISSION NUMBER r 1;) Notary Public . State of Florida
di Commission k GG 248590
My(UtWExpiresAug 14, 2022
SLCPDSD Revised 04/11/2011