HomeMy WebLinkAboutFILLED LAND AFFIDAVIT PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
• 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 =RECEIVEDFILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
CA514_ So/- G�6- oar ' -
(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 Na (PIe Pr'
Property O Si tore Date
STATE OF FLORIDA,COUNTY OF
AC KN WLrED BEFO ,,ppTHIS DAY O ,20 a l ,
BY 1. , S1 ALLY KNOWN TO ME Q OR WHO HAS
PRODUCED AS IDENTIFICATION.
11-11. AA
SIGNATUR OF N PUB TYPE OR PRINT NOTARY
COMMISSION NUMBER
KAREN S. NIELSEN (SEAL)
1�Y PUB�i
State of Florida Notary Public
Commission # GG 207484
y Commission Expires
`�` M June 12, 20Ex
SLCPDSD Revised 04/11/2011