HomeMy WebLinkAboutFilled Land Affidavit 1 C
PLANNING& DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
_ 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 f
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following de sc ibed7Fpe
(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 hither 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, f
adequate drainage off my property which will not adversely affect the immediate !
j community
Sys A�j B d 2 I o-r I
Property Owner Name(Please Print)
Pr424 Owner Signature Daic
STATE OF FLORIDA COUNTY OF _/vv/LJ(�C�/
AC O LED I r BE REM THIS .J DAY OF / ,20�
WHO IS PERSONALLY KNOWN TO ME(LPD WHO HAS
D AS IDENTIFICATION.
L�J
(tgNATUREOFNVTARYP BLIC TYPE OR PRINT NOTARY
f
COMM ON NUMBER
j (SEAL)
��v aver, SHERRI FE10M
C0MM"0n#GG 187160
Q Exp1c®s March 14,2022
SLCPDSD Revised 04/11/2011