HomeMy WebLinkAboutFilled Land Affidavit I
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f PLANNING& DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
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FILLED LAND AFFIDAVIT
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I,the undersigned, am the owner of the following described prope y, '
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(Parcel 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 beIadversely 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 er Name(P (eprint)
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Property owner Signature Date I�
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STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 17 DAY OF /V ` y 20 / /.
BY WHO IS PERSONALLY KNOWN TO ME Q OR WHO HAS
PRODUCED AS!IDENTIFICATION.
• y SIGNATURE OF NOT PUBLIC TYPE OR PRINT NOTARY p
COMMISSION NUMBER
(SEAL)
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SLCPDSD Revised 04/11/2011
AUDREY B.HUMPHREY
MY 160\OMISSION#FF 174772
EXPIRES:March 6,2019
Bonde' Thru Notary Puhlic.Untlen+rters
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