HomeMy WebLinkAboutFilled Land Affidavit i PLANNING&DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-6652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned, ai3 the owner of the following described prop A
� Fr".S tr-�- 4 � s -t- ( 13 Llrc. !A 4 oT 4.
Grog N LT' I.L4L'4 -TO -6/Af•ooa • �-/
(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,
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)
__Property Owner Signature,. Date
STATE OF FLORIDA,COUNTY OF
JyL
AC 7 EDGED BEFORE ME S_ DAY OF ,20
BY ONALLY KNOWN TO ME OR WHO HAS 2)
T AS IDENTIFICATION.
Sl TURE OF NOT IC TYP T NO ARY
COMMISSION NUMBER
(SEAL)
SHERRI FERMAN
Commission#GG 167160
SLCPDSD Revised 04/11/2011 * Expires Maroh 14,2022
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