HomeMy WebLinkAboutFilled Land ApplicationRECER"=D M
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,
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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 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.
o erty.Owner Name {Please Print)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF �A cK v �;\ V \
ACKNOWLEDGED BEFOREME THIS 1 V ' DAY OF ' 1 �/1. . 20 i
BY \�MV_� \ e 1 V - aV 1L a S WHO IS PERSONALLY KNOWN TO AM EZOOR WHO HAS
PRODUCED
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SIGRATURE`rO,�FNOTARYPUBLIC
V COMMISSION NUMBER
AS IDENTIFICATION.
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TYPE OR PRINT NbTARY
(SEAL)
s;�► Shelley L. Harden
SLCPDSD Revised 04111/2011 ommission # FF163050
7i� ires: SEP 24, 2018
BONDED THRU
1S[,FLORIDA NOTARx LLC, ;,