HomeMy WebLinkAboutFilled Land Affidavit- PLANNING &. 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,
S 000 Q t N r-i \1 U4
(Parcel Id#/Legal description/Address)
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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.
, %u gtruz0 i e-ILW a 0t?-
Property Owner Name (Pie Print) A
,1?ro erty Owner Signature ._ Date
STATE OF FLORIDA, COUNTY OF Sall r\ `' Lk u C
ACKNOWLEDGED BEFORE ME THIS DAY OF N OOVQ N �e r ' . , 20'+ 1
BY r i �lrT a K er n�WHO IS PERSONALLY KNOWN TOME ❑() OR WHO HAS
PRODUCED F--tori Ca Sk(%4 'DrNQr-s UssnjP AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC
FF9 `a- a9 COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
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TYPE OR PRINT; e I�!le''
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W MY comin. Expires? N =
March 28, 2020
• No. FF 976229
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