HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
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 described property,
�3 3s 3`1.5 yZ ,� nra )q NE A*-
3 -- i -- Q00'3 -- 000 — % — I Pls Lr--- q0
(Parcel Id#/Legal description/Address) /971 .S n k/tis X d Top—p. 30 S —Z/ 9(7)
Pl-,Pt?llee FL 34 9Y7J
for which I have applied to St. Lucie CoAty 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.
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Property Owner Nam (Please Print)
J a
Property wner Signature- Date
STATE OF FLORIDA,.COUNTY OF
ACKNOWLEDGED BEFORE
y E THIS � DAY OF
BY Yv1 6�� 6Y 4' OW^ WHO IS PERSONALLY KNOWN TOME ❑(�OR WHO HAS
PRODUCED Fl • bf l V'L►s 141U-44A AS IDENTIFICATION.
SIMAYME OF NOTXRY PUBLIC TYPE OR PFJrNT NOTARY
C a�yZ COMMISSION NUMBER
YEE
te of Florida
aGG 274408
22
SLCPDSD Revised 04/1 I/2011