HomeMy WebLinkAboutFilled Land Affidavitr
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LANDS AFFIDAVIT
JUL , , .'�j'I.
PERMITTii,IG
St. Lucie County, FL
I, the undersigned, am the owner of the following described property,,3L4QZ-467.6611-odo=,
fz1 4-e-' &A-) i 7-6 aL:0 LOT-S L47-t-g63
(Parcel
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 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.
Pr Ay Owner Name (Please P int)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
A0q4QWLEDGED BEFOF�E IvjE THIS _ DAY OF + 20�+
D W O IS PERSONALLY KNOWN TO ME___$0�911 WHO HAS
W06D AS IDENTIFICATION.
i
ATURE OF NiQTARP PUB "I'S CFR PRINT NOTARY
COMMISSION NUMBER
SLCPDSD Revised 08/24/2010
(SEAL)
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