HomeMy WebLinkAboutFilled Land Affidavit..;"j: `= • 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�) �-sIS�CSb�I 60 a --1 (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
that as owner of the above described property, and in accordance l witlh Sectdion
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL 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 whi
community. ch will not adversely affect the immediate
Property Owner Name (Please Print)
Property
gaature
Datc
STATE OF FLORJDA. COUNTY OF
ACKNOWLEDGED EIEFORE ME THIS _ _ DAY OF t 1414a�
By '� 20_
WHO IS PERSONALLY KNOWN TO ME
PRODUCED L �R WHO HAS
AS IDENTIFICATION
S NATURE OF N FAR UBLIC
TYPE OR PRINT NOTARY\1
4 l COMMISSION NUMBER
(SEAL)
SLCPDSDRevlsed04/11/2011 �•�r
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RICHARD DOUGLAS JOHNSON
Notary Public - Slele of Florida
COm-71451or.pGG084821
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My Comm Expires filar 20.2021
BunCeE lnrayA Nal,val Notary Am.