HomeMy WebLinkAboutFILLED LAND APPLICATIONPLANNING & DEVELOPMENT SERVICES DEPARTMENT
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,
1301-612-0328-000-1 / 6504 Bayard Rd. Fort Pierce, FI. 34951
krarcei 1<a;t/Vega1 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 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.
Treasure Coast Home Builders, LLC.
Property Owner Name (Pleas Print)
roperty Owner Signature Date
STATE OF FLORIDA, COUNTY OF& Jl U,
ACKNOWLEDGED BEFORE ME THIS - J $ DAY OF t' V n AffVj; e r— 20 2
BY V WHO IS PERSONALLY KNOWN TO ME (lam OR WHO HAS
PRODUCED rj 0 Mrs lielm s-e AS IDENTIFICATION.
SIGNATU4E OF XOTARY PUBLIC
ft:6 11145 COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
1L fRha cl
TYPE OR PRINT NOTARY
(SEAL)
1►AY n� AREZO E17D168527
Sri Notary
Q Public •Sta
+ @ Commission ; HMy Comm. Expires Bonded through National