HomeMy WebLinkAboutFilled Land Affidavit I
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE FL 34982-5652 I' -,
(772)462-1553 L— �-5 i t; E=;
FILLED LAND AFFIDAVIT
PERIIlITT ING
St. Lucie County, FL
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I,the undersigned, am the owner of the following described property,
��U M N�/� 1��.1 VC I )�RL� 3 y9�� I' PA�� �.�• 3Yod ou-oaoS-v no-v
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Deveqi
ent Permit. In
accepting this Final Development Permit, BP Number IT
b y_ b� , 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 bel 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.
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CSS W-AL-i S7AT.:T LL(
Prope Owner Name(Please Print)
erty Owner Signature Date
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�� U ASS
STATE OF CO Y OF
ACKNOWLEDGED BEFORE ME THIS_ DAY OF� �,20
BY �/ LIL T ;. it LAe- WHO IS PERSONALLY KNOWN TO ME(VI )OR WHO HAS
P UCED r AS IDENTIFICATION.
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nONAW L FELTER
SIGNATURE OF NO ARY PUBLIC NpTAFIXPI06 .W
OMMISSION NUMBER My Commission Expires Sept.16,2017
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(SEAL)
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SLCPDSD Revised 04/11/2011
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