HomeMy WebLinkAboutFilled Land Affidavit (2)a
9 VCME U
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,
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 , I acknowledge
that as owner- ofthe above described property, and in accordance with Section 7.0.4.01(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 int)
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Property Owner Signature V Date
STATE OF FLORIDA, COUNTY OF A4,W
SWORN TO. (OR AFFIRMED) AND SUBSCRIBED EF RE ME OF ZPHYSICAL PRESENF
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ONLINE NOTORIZATION THIS DAY OF 0 20
NAME OF PERSON MAKING STATEMENT
PERSONALLY KNOWN ✓/ OR PRODUCED IDENTIFICATION
TYPE OF ID ATION PROD D
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COMMISSION NUMBER �,�QSL� �`�G'•�•'•�
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SLCPDSD Revised 03/10/2022 Ordinance # 2022-2 �y C,L! 37F