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,
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(Parcel Ill#/Le al description/Address \� 1
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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.
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Property Owner Name (Please Print)
Property weer Signature Date
STATE OF FLORIDA, COUNTY OF - A)(: j 'QD
ACKNOWLEDGED BEFORE ME THIS
r a DAY OFyV-tY1 200
BX UJ\I\16)n/ ,S h (Q J :T "IWHO IS PERSONALLY KNOWN TO ME ( OR WHO HAS
PRODUCED V 2-LIO `23r509 0L4 71O %D r N C S U G�9y3{ AS IDENTIFICATION.
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SIGNATURE OF NOTARY PUBLIC TYP OR PRINT NOTARY
(ate 9 a � COMMISSION NUMBER
SLCPDSD Revised 04/1112011
(SEAL)
4P NNotary Public State of Florida
Robin L Bowen
-w My Commission GG 29021-2
p wdF Expires 02/04/2023