HomeMy WebLinkAboutFILLED LAND APPLICATIONPLANNING & 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,
3414. S-0 t + ROCS 100•5
(Parcel Id#/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.
Property Owner Name (PIVase Print)
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Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
ACKN EDGED BEFORE ME THIS DDA 1 OF 20 / !�
WHO IS PERSONALLY KNOWN TO ME (�.OR WHO HAS
PRODUCED vV r C AS IDENTIFICATIIO�N..�
SIGNATURE OF NOTAR11 PUBLIC TYPE RINT NOTARY
NUMBER
(SEAL)
SLCPDSD Revised 04/11 /2011
ot�•Y "gym.; AUDREYB. HUMPHREY
+: MY COMMISSION # FF 174772
EXPIRES: March 6, 2019
Bonded Thru Notary Public Undanwriters
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