HomeMy WebLinkAboutFilled Land AffidavitSIGAAT IFNOTARY PUBLIC
G606 YB COMMISSION NUMBER
�-._.. PLANNING & DEVELOPMENT SERVICES DEPARTMENT
• Building & Code Regulations Division
2300 VIRGINI A AVENUE .
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number JJD-bZ&LI 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 &at 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.
property Owner Name (Please Print)
roperty Owner Signature
STATE OF FLORIDA, COUNTY OF JA/N� L. UGILc
Date
ACKNOWLEDGED BEFORE ME THIS � � DAY OFy�%�/J � 20.LLB
BY / R414 C�.f��G��jp � ,,,;eL WHO IS PERSONALLY KNOWN TOME (El OR WHO HAS
PRODUCED AP4 L�XPIRe S 0 Z — 1 — 2 d l.9 AS IDENTIFICATION.
TYPE OR PRINT NOTARY
(SEAL)
�• ti 1:°Qa/•. GARY BAKER
SLCPDSD Revised 0411 U201 I MY COMMISSION # GG 064548
EXPIRES: AM21.2021
•,�% :Qom' Balled TTvu NolarY Public Undehrft