HomeMy WebLinkAboutFILLED LAND AFFIDAVITRECE1',":F' �I_ 2 0 3016
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,
Laz4f ,6�loGk , AVralov, Q:k-1ti�{�.t1.�. 0.ccrn2cl�'�,q �o 4e wt ,
(Parcel d#/Le al descri tion/Address)
0-s Y•ec ed 1�-�c �i'"�ook 55, eMe 19 , ul�l;c aecor�s of Luce Llou-kt4�,
for which I have applied to St. Lucie County for a Final Development Permit. In FL6V-1DA
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.
Prop lie (Please Print)
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Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFjRE ME THIS DAY OF 20
Cy -
BY r -,�I 92 11 WHO IS PERSONALLY KNOWN TO ME �rOR WHO HAS
P ODUCED jj AS IDENTIFICATION.
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P4T Y I C 4. I I IJ�Up 4X e✓
SIGNATURE OF NOT UBLI TYPE OR PRINT NOTARY
COMMISSION NUMBER
OPaMda
NOTARl
STATE OF FLORIDA
EXPres
Comm# FF02MI
SLCPDSD Revised 04/11/2011 6/12/2017