HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & 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,
IM "IgA2-i310-ooj0 -ao0l8 511 m w W;n4.ers C, 2. y, j ►► C; �y Vic.
(Parcel Id#/Legal description/Address) 34 ciclo
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 (Please Print)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF rri A R T 1 W .
ACKNOWLEDGED BEFORE ME THIS DAY OF NJ a V ,20 11
BY L i 5 ti AT- S% a r WHO IS PERSONALLY KNOWN TO ME V/ OR WHO HAS
PRODUCED
a 4 -la diz IA-) F j,—
GNATURE OF NOTARY LIC
COMMISSION NUMBER
SLCPDSD Revised 08/24/2010
TYPE OR PRIPT NOTARY
E
aunp
,•oi►s'YP�e'j;,� BRANDY WATLEY
: •° : Notary Public - State of Florida
My Comm. Expires May 9, 2014
Commission # DD 989743
AS IDENTIFICATION.