HomeMy WebLinkAboutFilled land aff I .
-0 PLANNING & DEVELOPMENT SERVICES DEPARTMENT
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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 describedproperty,
(Parcel Id#/Legal descripti Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number LJ 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.
I
Property Owner Name ase Print)
/J 7 2-
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF /�'
ACKNOWLEDGED,BEFORE ME THIS DAY OF � 20_IV_'
BY ni CQ- AG tl a MMO IS PERSONALLY KNOWN TO ME(n OR WHO HAS
PRODUCED AS IDENTIFICATION.
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SIGNATURE OF NOTARY P613LIC TYPE O PR PRII f QOOTTARY t
GG9W11COMMISSION NUMBER. I
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ate of Florida-AUC'Fl
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SLCPDSD Revised04/11/2011 Milo, MY Comm # GG 27 0791iQ
October 22,2022ires