HomeMy WebLinkAboutFilled Land AffidavitPLANNING & 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,
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.
0 P to- 0A
Property Name (Please Print)
Prop weer Signature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _ n DAY
OF 20 Iq.
� ' / � A
BY 1 &'��y �� `WHO IS PERO.S AULY KNOWN TO ME (a OR WHO HAS
PRODUCED
COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
OR PRINT NOTARY
(SEAL)
AS IDENTIFICATION.
AUDREYB.HUM MY
W COMMISSION # GG W18'f 7
E)(PIRES: March 0. 2028
eorb9d11W N0!ery Pub!!,. Underyti