HomeMy WebLinkAboutFilled Land AffidavitLucie County for a Final
Permit, BP Number
adequate drainage off my, property
community.
Property Omer Name (Plea:
Property Owne
i�t)
that as owner
7#04201(D), St.
PLANNING 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
6A
(Parcel ld#/Legal descrypti
on/Addre-
S)
for which I have applied to St.
accepting this Final Development
of the above described property, and ill
Lucie County Land Development Code, I shall
A A..dk JI
TV r
3
Development Permit. In
I acknowledge
accordance with Section
be responsible for assuring
adecluate drainage so that the immediate community WILL NOT be adversely affected
I further acknowledge that m granting this permit for the development of this property
St. Lucie County is neither obliged nor 11'able to provide for, or maintain u*-i any form,
which will not adversely affect the immediate
ignature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF
BY '�-- � r
PRO � ED !� VL)
,o WHO IS PERSONALLY KNOWN TO ME
Fj- .. - P44F
SIGNATURE OF NOT Y PUBLIC
bk
COMMISSION NUMBER
S LC PD S D Revised 04/11 /2-0 0 11
OR PRINT NOTARY
SEAL)
OR WHO HAS
DENTIFICATION.
11 11111111in
• .. � ... 11 -� ��._4 _M1.'.•.. s� t i•-• try
I L _ •t
4