HomeMy WebLinkAboutFilled Land Affidavit � I
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PLANNING& DEVELOPMENT SERVICES'DEPARTMENT
COUNTY
Building& Code Regulations Division d
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
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FILLED LAND AFFIDAVIT
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I,the undersigned, am the owner of the following described property,
(Parcel Id#/Legal description/Addr ss)
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 grantingthis permit for the 'develo ment of this property,
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St. Lucie Count is neither obliged nor liable to provide for or maintain in an form
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adequate drainage off my property which will not adversely affect the immediate
community.
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operty Owner Name(Please Pr' t
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"p-W10wrier Signature I V Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS D DAY OF Cx; r I ,20 2
BY e L WHO IS PERSONALLY KNOWN TO ME LffOR WHO HAS
PRODUCED( )In)'�ed S�-(es 11n►&-Me�rVI AS IDENTIFICATION.
S ATURE F NOTARY PUBLIC TYPE OR PRIM NOTARY
L16 6 COMMISSION NUMBER
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SLCPDSD Revised 04/11/2011 00 P(4 Notary Public State of Florida
44 1�1 Jeremy Matthew Malvan
i My Commission GG 304020
4i' d Expires 0212012023
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