HomeMy WebLinkAboutFilled Land AffPLANNING & DEVELOPMENT SERVICES DEPARTMENT
j - 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,
aL(.3(e -33(- 001- boo _- y as 5. -:rnbd," D12.
(Parcel ld#/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, 1 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.
S� fir-.✓ �,c Q �: /�/�
Property Clter Name (Please Print)
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Prnperty06wricr Signature Date
STATE OF FLORIDA, COUNTY OF ST Ue
ACKNOWLEDGED BEFORE ME THIS — 7 -- DAY OF
PRODUCED
20-AI
FF_ WHO 1S PERSONALLY KNOWN TO ME (M) OR WHO HAS
5� Ssd
SIGNATURE OFNOT ARY PUBLIC
SLCPDSD Revised 04, l 12011
COMMISSION NUMBER
AS IDENTIFICATION.
KerryA. Sisson
TYPE OR PRINT NOTARY
EKiiE
lic State of Florida
ssonsion GG 950211
22/202A
(SEAL)