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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
R,-Odmg & Cadc, ftulations DiYisian
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,
Id#/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 WILL NOT be adversely affected.
I further acknowledgethatis granting this permitt 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.
PropOwner Name (Plepse Print)
f/V/O - /9- 2-
Signature Date -
v
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF �Q�� 20,
BY nVP YeA CAAIQ WHO IS PERSONALLY KNOWN TO W OR WHO HAS
PRODUCED
GNATUREOFNOTAR UBLIC
COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION.
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(SEAL)
Vr •ham
Notary Public State of Florida
OanyelJones
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My Commission GG 352016
Expires07/04/2023