HomeMy WebLinkAboutFilled Land Affidavit L Eu*g
PLANNING&DEVELOPMENT SERVICES DEPARTMENT
BUILDING&CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LANDS 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, Building Permit Number , I acknowledge
that as owner of the above described property,and in accordance with Section 7.04.01(D)3,
Filled Lands, St. Lucie County Land Development Code, I shall be responsible for
submitting a stormwater grading plan assuring adequate drainage so that the immediate
community will not be adversely affected. I agree to retain. an engineer or other design
professional if the stormwater grading plan fails; and, agree to hold St. Lucie County
harmless for any future drainage rework that may be required as a result. 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.
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Property Owner Name(Please Print)
Property Owner i re D to
STATE OF FLORIDA,COUNTY OF � ' I�.�i'w�C_
SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME OF PHYSICAL PRESENCE OR
ONLINE NOTORIZATION THIS A DAY OF 20r,-}/—
NAME OF PERSON MAKING STATEMENT L�
PERSONALLY KNOWN OR PRODUCED IDEENTIFICATION ►T
TYPE OF IDENTIFICATION PRODUCED
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SIGNATURE OF N ARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER pY PU AUDREY B.HUMPHREY
,�_ MY COMMISSION#GG 300817
( AL e= EXPIRES:March 6,2023
pr ?I Public Underwriters
rFOFM 8ondedThruNotary
SLCPDSD Revised 03/10/2022 Ordinance#2022-2