HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
13UILDING & 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, 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 drainao off my property which will not adversely affect the immediate
Ko�perlty Owwn"er ame (Please Print)
1 e&d
Property Owner Signature
STATE OFfr COUNTY OF
I -ZO 1�
Date
ACKNOWLEDGED BEFORE ME THIS a O DAY 20 ) q
BY 1p` P,+ e_A , WHO IS PERSONALLY KNOWN TO ME XJ OR WHO HAS
PRODUCED AS IDENTIFICATION.
.•—
SIGNATURE OF NOTARY PUBLI
COMMISSION NUMBER
SLCPDSD Revised 08/24/2010
P. kCp \'N6
TYPE OR PRINT NOTARY
(SEAL)