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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LANDS AFFIDAVIT .
I, the undersigned, am the owner of the following described property,
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(Parcel I0/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 WELL NOT be adversely affected.
I f other 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 m any form,
adequate drainage off my property which will not adversely affect the immediate
community..
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Property Owner Name (Please Print)
Property Owner Si tune Date
STATE OF FLORIDA, COUNTY OF -\
Fes\ ail S1
BEFORE ME THIS DAY OF
20
ACKNOWLEDGED
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BY l C �
IS PERSONALLY KNOWN TO ME
OR WHO HAS
PRODUCED
IDENTIFICATION.
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=a;aY P`; <'s "lotary Public - State o1 Florida
3 * ; •E M Comm Expires;Jan 23.2015
SIGNATURE OF NOTARY PUBLIC
= �' ' c 3'PE q) PRII.(Ti:N0TAR)512 7 8
Notary Assn.
COMMISSION NUMB-y-wv
(SEAL)
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SLCPDSD Revised 08/24/2010