HomeMy WebLinkAboutFilled Land Affidavit i
i
_ PLANNING&DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGRdA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 ®V 2
2 0 201?
FILLED LAND AFFIDAVIT PiR:U71 TiNG
St. Lucie County, FL
a
I,the undersigned, am the owner of the following described property,
SZ03
(Parcel Id#/Legal description/Addr s) Z-lid eje l RI Vir' 1to¢e t Lh./f-7 5 ll- 5 2 L
I
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,1I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
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.
Property Owner Name(Please Print)
Property Signature Date'
STATE OF FLORIDA,COUNTY OF `2
ACKNOWL4WED BEFORE ME THIS 17-DAY OF /Y '2 `
--- - - I- - J
LLY - --
BY --- - - - - -- - -- WHO IS PERSONA KNOWN-TO ME(; )OR WHO HAS -- -
PRODUCED AS IDENTIFICATION.
SIGNATURE OF NO ' C TYPE OR PRINT NOTARY
I
COMMISSION NUMBER
i
ro�'RY A, (SEAL)
* Jeff Simon
MycO date OfFlodda
of�oP mmission
SLCPDSD Revised 04/11/2011 C°mmission N&0 s 031112p1g'
` F 1005332
I