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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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.
n li�, g—e 6E E U S k
Property Owner Name (Please Print)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF -
ACKNOWLEDGED BEFORE ME THIS j� DAY OF \ 20_,
BY �7rc\01S S \ WHO IS PERSONALLY KNOWN TONE JQ� OR WHO HAS
PRODUCED
'::1TURE NOTARYPUBLIC
COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION.
TYPE OR PRINT -NOTARY
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NoUry P: tNs o1 Florid -a
Commission # FP 205666
My Comm. Expires Apr 1. 20
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Bondi theu4h National Notary _. .