HomeMy WebLinkAboutFILLED LAND AFFADAVITPLANNING & 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,
(Parcel I(1#/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 fitrther 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.
VNOM( )\ GSGc4�-
Property Owner Name (Ple a Print)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF__ .�
ACKNOWI,EI)CiF.D BEFORE N9E "I'llIS Z ` DAY OF ` e ` �T 2027-,
BY �&<Q\ \ n �LN �✓ 1VI IO IS PFRSONAI.LY KNON1'N TO \IF: C[32) OR 1VIIO IIAS
PRODUCED
s 1.101'1�
SIGNATURE OF NOTARY PUBLIC
�G-I COh1i\1ISSION NUMBER
SLCPDSD Revised 04/I I/2011
TYPE OR PRINT NOT�r\Rl'
AS IDENTIFICATION.