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
the unde .sl _ ed ain
awl Tb4 ��al��-ttl= o-p�
(a SG NLIrsai
A �nl-.GS,Si
(Parcel IM/Legal denript
,4" LC5s Rh K kl f3S 4VOR 1$05-
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.
i Owner Name (Please int)
/Owner Signature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS /-J-- DAY OF /V OV IeM
If
BY S 2 l� i 11f WHO IS PERSONALLY KNOWN TO ME ([a OR WHO HAS
PRODUCED
IDENTIFICATION.
�— ��-I-ri era Az,-� e�
SI NATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
66Ub90-6-J�LCOMMISSION NUMBER
' PATRICIA A. HOWE tom)
�} MY COM OSSION # PF069060
�oFns� ��� Nov�ba 07, 2017
SLCPDSD Revised 04/11/2011