HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
g�I4-SoI. 140q- 3SO-0
(Parcel IM/Legal description/Address)
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.
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Property Ov er N me (Please Print)
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Property Owner Signature
STATE OF FLORIDA, COUNTY OFy .��U
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1 1'.OT-)
Date
ACKNOWLEDGED
I BEFORE ME THIS __.._._._ � ._.._ DAY OF ._._N._O`✓e—VY--)I r . 20._ 1___
BY Pp ra6� C L Ji Y I�VIIO IS PERSONALLY KNOWN TO ME (�C) OR W F{O HAS
E_........... /.._
i
IRE OF NO Y
CSC CRMWOMMISS[ON NUMBER
SLCPDSD Revised 04/11,12011
AS IDENTIFICATION.
M c of c- FilcnSol'1
TYPE OR PRINT NOTARY
NICOLE ELLENSON
MY CQA461$§ION #GG089104
EXPIRES: APR 02, 2021
Bonded through 1st State Insurance