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,
(Parcel
Address)
-0027 - cco- 7
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , 1 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 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.
!fit Ou!ner Name {Pleased t:)
/V\
Propertygm a gnalfe Date
STATE OF FLORIDA, COUNTY OFT /II jGl e7 '� I A)-e
ACKNOWLEDGED BEFORE ME THIS DAY OF 0e--T 20
BY _ (Zil 1 L l° ► J b IMWHO IS PERSONALLY KNOWN TO ME JE-1) OR WHO HAS
PRODUCED
r
SIGNATURE OF NOT Y PUBLIC
COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
Al I T 41 11
TYPE OR PRINT NOTARY
— -t"m- -
140 Notary Allen
J State of Florida
Allen J Bell.
- mycommissionIslas?
°; EXP. 0/412026
AS IDENTIFICATION.