HomeMy WebLinkAboutFilled Land AffiavitPLANNING & 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,
- AN
(Parcel Id#/Legal description/Address)
for
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 thetimmediate 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.
ck:l
;Property Name (Please Print)
operty Owner Signature Date
STATE OF FLORIDA, COUNTY OF (S s �Lc l
ACKNOWLEDCjEa BEFORE ME THIS DAY OF G 20
BY C,Y 11�L J} (if WHO IS PERSONALLY KNOWN TO ME (a OR WHO HAS
PRODUCED
OF
SION NUMBER
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION.
1�_fi 0 1 WV- �J tD,#�
TYPE ORP NOTARY
P
'�', FRANCEN e NEWMAN
Nota Public .State of FloridaryCommission 4 HH 236446
F :' My Comm. Expires May 23, 2026
Bonded through National Notary Assn.