HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
R 2300 VIRGINIA AVENUE
!� FORT PIERCE, FL 34982-5652
(772)462-1553
JUN / 6 2016
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
(Parcel Id#/Legal description/Address) T Esl\4.
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.
Prope Owner Name (Please Print)
Property Owne ignature Date
STATE OF FLORIDA, COUNTY OF S ` • VV C Q-
ACKNOWLEDGED BEFORE ME THIS 93 DAY OF mflu 120j-4p--
U
BY WHO IS PERSONALLY KNOWN TO ME --M— OR WHO HAS
PRODUCED AS IDENTIFICATION,
WIG4� O NOTARY PUBLIC TYPE OR PRINT TARY
1'F1 COMMISSION NUMBER
(SEAL)
JEFFREY CARLSON
SLCPDSD Revised 08/24/2010 MY COMMISSION #FF124127
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•-•.'ForFl.e�;.• EXPIRES May 18, 2018
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