HomeMy WebLinkAboutfilled lands affidavitr--
g ,t> Will RECEIVED
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i MAR 3 0 2022
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St.Lucie County
Permitting
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,
jfi2G-903 oaLQ)-0�0�8, 16-30 .k),Lj_ S��eT6�� Gt,�L P�l_t Ck.T.S ►"�-
(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 �2_IDJ --03cR , 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)
Propeo7owner Signature Date
STATE OF FLORIDA,COUNTY OFn'tG C
SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME OF PHYSICAL PRESENCE OR
ONLINE NOTORIZATION THIS 15 DAY OF 20 2Z ,
NAME OF PERSON MAKING STATEMENT
PERSONALLY KNOWN OR PRODUCED IDENTIFICATION
TYPE OF IDENTIFICATION PRODUCED
�SIIGNATURE OF NOTARY PUBLIC TYPE OR PRIAT NOTARY
COMMISSION NUMBER �pNuuj%
Y P&4� Jacqueline Shakes
(SEAL) ' Comm.#HH084128
Jan.24,2025
Dw Aam Notary
SLCPDSD Revised 03/10/2022 Ordinance#2022-2