HomeMy WebLinkAboutFilled Land Affidavit I
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PLANNING & DEVELOPMENT SERVICE'S DEPARTMENT
o Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652 j
(772)462-1553 j
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FILLED LAND AFFIDAVIT
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I, the undersigned, am the owner of the following described property,
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_L30i-(d_3 15/7/ ocxa-7 �1e4, �J f v/c LULtiy 31k Q A-
(Parcel Id#/Legal description/Address) r7Qa,3
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number I , 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 WIL�i L 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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a rd M e
Pro rty Owner Name(Please Print)
Property Owner Signature Da e
STATE OF FLORIDA,COUNTY OF S T. LU C I E
ACKNOWLEDGED BEFORE ME THIS r DAY OF ZANu Ar!fLY 201? ,
BY r 1DLv A IZ9 M E(47',- WHO IS PERSONALLY KNOWN TO ME D OR WHO HAS
PRODUCED D R.1 V etz'S L.1 C ENS E AS IDENTIFICATION.
—d6*4.�M. Zm 4 j
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
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FF 4!3 Z y o COMMISSION NUM
r'P'�0 OONALD M.D91�3240�
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Notary Public-
= Commission#, ? My Comm.EzpinBondedf oughNO
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SLCPDSD Revised 04/11/201 I
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