HomeMy WebLinkAboutFilled Lands Affidavit i
e PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division RECEIVED
kilo 2300 VIRGINIA AVENUE
FORT PIER ,F L553 82 5652 MAR o
7 2022
JI.,Lucie County
Permitting
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
ImaL � —
b
(Parcel 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 ; 1 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 Owner Name Please Print
P Y � )
operty Owner Signature Date
STATE OF FLORIDA,COUNTY OF ST
ACKNOWLEDGE�D BEFORE ME
THIS
yT DAY OF
BY IR�1/r,U r�� � I`) 1 WHO IS PERSONALLY KNOWN TOME L[—])OR WHO HAS
PRODUCED /' A AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
KAREN $SI1,FLSEN
RY PU�i
;state of Florida-Notary public
N
Commission # GG 207484
�� My Commission Expires
June 12, 2022
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SLCPDSD Revised 04/I1/2011