HomeMy WebLinkAboutPursuit Tooling Filled 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,
14 k - dil � ovol - oor'j — (o
(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
T04 . 01 (1)) , 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.
T
Property Owner Name (Please t)
Property Owner Signature Date
STATE OF FLORIDA , COUNTY OF
ACKNOWLEDGED BEFORE ME THIS ! DAY OF �, • 20
BYQaG WHO IS PERSONALLY KNOWN TO ME (j]rOR WHO HAS
PRODUCED AS IDENTIFICATION .
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I N RE OF Nbrr&RY fU1 LI TYPE OR PRINT NOTARY
2 COMMISSION NUMBER
so% P�� ( SEAIWGER A . PRIEST
' jr* � � ; Notary Public - State of Florida
Commission # HH 19924g ' My Comm . Expires Nov 7 , 2024
Bonded through National Notary Assn .
SLCPDSD Revised 04/ 11 /2011