HomeMy WebLinkAboutFilled Land AAffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division REGENED
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 JAN 12 ZOZZ
St. Lucie County
Permitting
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
plyce11D 133�-�f �/�-O�c�3—ooa—! (,egnl deSev. �!� 3q 37 s9 I py•IeSS dv i6 F4 and
(Parcel W/Legal description/Address) Le--- 'S ` z;u (K" and LC%5 rct 9:1w - ( a % •`t t R L /
A c+ eems. s- a I IS K.e e r, (A %Fierce- R, 3 M K
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.
D ol'ilcAm fiefs
Property Owner Name (Plea a Print)
ta�� / //.I ]'-� a -
Property Owner Signature Da e
STATE OF FLORIDA, COUNTY OF Jf• L-uCl',
ACKNOWLEDGED BEFORE ME THIS 1 /�-- DAY OF 20 ,
BY { r'id WHO IS PERSONALLY KNOWN TO ME (_) OR WHO HAS
PRODUCED
JJ SIGNATUI>Clj�QCRY PUBLIC
i" I COMMISSION NUMBER
SLCPDSD Revised 04/1112011
AS IDENTIFICATION.
NAQ -T1i n
TYPE OR PRINT NOTARY
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