HomeMy WebLinkAboutFILLED LAND AFFIDAVIT\I
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINU AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
o-7 5 - F-w - PV
(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 ZO r Z —060 & 6, 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 ame (Please inn �y
ofn
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
..001
ACKNOWLEDGED BEFORE ME THIS DAY OFd�
20
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BY 1 W%�/
� - / ' J-,aZ` ,IWHO IS PERSONALLY KNOWN TO ME (� OR WHO HAS
PRODUCED
SIGNATURE OF NOT PUBLIC
CO MISSION NUMBER
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION.
PRINT NOTARY
(SEAL)
AUDREY B. HUMPHREY
MY COMMISSION # GG 300817
%Q EXPIRES: March 6, 2023
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