HomeMy WebLinkAboutFilled Land Affidavit — -- PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 3498_2-5652
(772)462-1553
FILLED LAND AFFIDAVIT
L the undersigned, am the owner of the following described property.`J
�� QC-C� 1 J �f� J• 1�7 ���� CSC
(Pat-eel IM/Legal description/Address)
for Which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Perrnit,.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 N ILL NOT be adversely affected.
I hlrther 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 forin,
adequate drainage off my property which will not adversely affect the immediate
community.
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Pro e ty ame(Please Print)
ro ;;e,Signature Dal
STATE OF FLORIDA.COLnITY OF S} l�1Aci
ACKNOWLEDGED BEFORE NIETHIS DAY OF -)o L7�
BY_ ,a� b r W'\ WHO IS PERSONALLY KNOWN—TOO LAE(_0)OR WHO HAS
PRODUCED- 3 S _ - �� AS iDENNTIFICAI ION
4SI,N/AT::1LT�RE
r 40 6' b:evL OF NOTARY PUBLIC TYPE OR PRIN"r NOTARY
(y at 2 CONINIISSION NUbIBER
.18SION�0.932988
a`= EXi• ES:November 19,2023
%'.�or ��••' sondod;rru Notary Pubic 1lndet*dws
SLCPDSD Revised CAN 1'2011