HomeMy WebLinkAboutFilled Land Affidavit I�
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
5
Building&Code Regulations Division
gale
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following describe roperty,
d
(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.
t01p3e2r_tyi0Wner Name(Please Print) f•1
LV
6Prope wner Signature Date
STATE OF FLORIDA,COUNTY OF d-1- C J----
ACKNOWLEDGED BEFORE ME THIS DAY OF ,20C971 ,
BY n� WHO IS PERSONALLY KNOWN TO ME 0 OR WHO HAS
PRODUCED I/� AS IDENTIFICATION.
SIGNATURE UP
N T PUBLIC TYPE OR P T
6 6OD 6 V liCbMMIS SION NUMBER '"""1'.
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SLCPDSD Revised 04/11/2011