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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 4624553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
,2_Zm�►P 3s�11/S
Id#/Legal description/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.
Property Ownef Name (Please Print)
Property O 71r
Signature Date
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STATE OF FLORIDA, COUNTY OE/1k„( (atC-4 'C
ACKNOWLEDGED BEFORE` METHIS � s� DAY OF 1VOUev1n� 2rr_ 20 jx1
BY/ Li4 L, W Q� S S WHO IS PERSONALLY KNOWN TOME ❑( Jj OR WHO HAS
PRODUCED faA �ruJ �ie2 S AS IDENTIFICATION.
TranICG n 1e y,
OF TYPE OR PRINT NOTARY
66 W21 Z COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011
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®My Comm. Exple6 May 12, -2024
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