HomeMy WebLinkAbout 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
1,the undersigned,am the owner of the following described property,
9yaY
(Parcel IM/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-C-ounty-is-neither-obliged-nor-liable-to-provide-fo -or-maintain-in-any-form;-- - --
adequate drainage off my property which will not adversely affect the immediate
community.
Property Owner Name(Please Print)
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF
n s�
ACKNOWLEDGED BEFORE ME TIES L' DAY OF .6A,— 20 *—
BY WHO IS PERSONALLY KNOWN TO ME CO)OR WHO HAS
PRODUCED AS IDENTIFICATION.
ATURE OF N AR LIC E OR PRINT NOTARY
3 CODIMSSION NUbMER
(SEAL)
.� Notary Public State of Fbride
SLCPDSD Revised 04/1 F/2011 Lgnp
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