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,
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(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 > 761U(--'p , 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 Owner Name ease Print)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
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A OWLE��I�BEF-ORE ME THIS \ DAY OF 20:�
B I��2Sx KNOWN TO ME OR WHO HAS
PROD CAS I ED �� <���s DENTIFICATION.
SIGNATURE OF NOTARY PUBLIC ., _T)'EQR2RQ[EXOTARY
ER TTE GALLO
111040 Public - State of Florida
ifoMMISSIon N FF 951456 (SEAL)
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SLCPDSD Revised 04/11/2011