HomeMy WebLinkAboutFilled lands 3194PLANNING & 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 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 Owner Name (Please Print)
_______________________________________ _______________
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF______________________________
ACKNOWLEDGED BEFORE ME THIS ______________ DAY OF ______________________________, 20________,
BY _________________________________________WHO IS PERSONALLY KNOWN TO ME (____) OR WHO HAS
PRODUCED ______________________________________________________________________ AS IDENTIFICATION.
__________________________________________ ______________________________________________
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
_________________COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011
3194 Airmans Dr., Fort Pierce Fl. 34946