HomeMy WebLinkAboutFilled Land Affidavit wqn
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,
&'70o? A�Q/7 K t QO CGS Jul �y'G2 Li cT�Gc�I
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Developm nt Permit. In
accepting this Final Development Permit, BP Number o-[�',— , I acknowledge
that as owner of the above described property, and In acc07dan e 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.
Proper Owner Name(Please Pri.
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF f 120 r—QJ,
BY N `pn ��\,r I / a WHO IS PEIj�SONALLY KNOWN TO ME(ob OR WHO HAS
PRODUCED `y 1' l� \f AS IDENTIFICATION.
SIGNA E OF NOTAV PUBLIC TYPE OR PRRYF N�1 AR Y LJ
COMMISSION NUMBER
SEAL)
s ELLEN EAU _ .
c tate of Florida Nota NN
Commissi y Public
,; �`� MY Commis# OG 270079
SLCPDSD Revised04/11/2011 October Sion Expires
b 22, 2022