HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGUZA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
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FILLED LAND AFFIDAVIT -�Gc
I, the undersigned, am the owner of the following described pro 3 �c 9 S L
3'.41y -56I - 1 [c) 7 - USo - 0 d401 T11t1DA
��' L(�c12 Gatrd�nS 2� 3l0 40 6Uc 3 W I loS'FT LOT
(Pared Id# A%d description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number 1 1y 6 - 6F 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.
Pr er "me (Pleose-Print)
Signature Date
STATE OF FLORIDA, COUNTY OF V C/
- ACKNOWLEDGED BFORE METHIS � DAYOF r 1' II� WHO 1S PERSONAILL `Y KNOWN TO NF(Ej OR WHO HAS
PRODUCED 1 1A J v
� auab Lmk_
IGNAT UREE OF NOTARY PUBLIC
IO u C MCOM IISSION NUMBER
SLCPDSD Revised 04/112011
AS IDENTIHCATION.
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AORPRIN&UrARYC
(SEAL)
ALANAHREGAN
Notary Public- State of Florida
P ` Commission # GG 106239
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My Comm. Expires May18,2021