HomeMy WebLinkAboutFilled Land ApplicationPLANNING & 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 Id#/Legal description/Address)
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for which I have applied to St. Lucie County for a Final Development Permit. In
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accepting this Final Development Permit, BP Number �i�a.-��� g
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)
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Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 20 ce.,
BY WHO IS PERS ALLY KNOWN TO ME d1—:1 OR WHO HAS
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SIGNATURE OF NOTAkY PUBLIC
COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION.
OR PRINT NOTARY
(SEAL)
AUDREY B. HUMPHREY
MY COMMISSION # GG 2 17
�'" •'z' EXPIRES: March 6, 2023 '
Bonded ThruNotary Public UndetwritersV1r