HomeMy WebLinkAboutFilled Land AffPLANNING & DEVELOPMENT SERVICES DEPARTMENT
3" 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,
1423-566-0004-000-9
(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.
Ul /-- ,Ua
Name (Please Print)
, ayd- s /a,
Owner Signature Date
STATE OF FLORIDA, COUNTY OF 5/ LU C 1,
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ACKWWLEDGED BEFORE /MBE THIS
,, � )� �+ DAY OF P � I/ J 2a 1
BY I n QQ ( 1A&[4) � pWHO IS PERSONALLY KNOWN TO ME Q OR WHO HAS
ODUCED IJ� ty 1C ( ) 1) i C n ai L AS IDENTIFICATION.
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SIGNATURE��/IOFCCN,,OTARY PUBVV TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
�.►yn '°W� Notary Public State of Florida
Heather Vizzo
SLCPDSD Revised 04/11/2011 r My Commission GG 262653
''�s a- Expires 11113/2022