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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations .Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFI.DAVIT
1, the undersigned, atn the owner of the following described property,
Mal
(Parcel id#/Legal
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.
A�Au-z-
PropertTOwner Name (Pl ase Pr' t)
30
Property Owner Signature Dad
STATE; OF FLORIDA, COUNTY OF ��! nt L.CI et
ACK`NNOWL�E'QD/GEED� BEFORE /MF, T�HIiS} � DAY OF Li I If JC i 201�,
BY IJ �1i4 LL O� '711�1�1 `� f WHO IS PERSONALLY KNOWN TO ME LX) OR WHO HAS
SIGNATURE OF NOT� PUB=.
CCIC)Fq C) COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION.
V U l— F'I I-eil l o+ f
TYPE OR PRINT NOTARY
NICOLE ELLENSON .
n MY COMMISg%:G089104
EXPIRES: APR 0 , 2021
Bonded through 1st State Insurance