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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,
Palm City, F1 34490
(Parcel Id#/Legal description/Ad
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.
Scott Harala
Property Owner Name (Please Print)
41k �W( b
Property er Signature Date
STATE OF FLORIDA, COUNTY OF Broward
ACKNOWLEDGED BEFORE ME THIS ZO DAY OF 20 16
BY Scott Harala
PRODUCED
SIGNATURE
SLCPDSD Revised 08/24/2010
WHO IS PERSONALLY KNOWN TO ME
Denise Brown
Y PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
OR WHO HAS
AS IDENTIFICATION.
;z�"• rjE BROWN
_•*_ ssion # FF140607s November4, 2018
10
F oz,;
' Bonded Thru Troy Fain Insurance 800.385-7079