HomeMy WebLinkAboutFILLED LAND AFFIDAVITJ/
1
RECEIVED
PLANNING & DEVELOPMENT SERVICES DEPARTME T
Building & Code Regulations Division FEB 14 2018
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652 ST. Lucie County, Permitting
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
3yo2 -6o1- U)_lq 60(�I
(Parcel Id#/Legal
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.
wV o5h tpve
Property OAmer Name lease Print
Property Owner SignatU6 Date
STATE OF FLORIDA, COUNTY OF V O I S I.GL'
ACKNOWLEDGED BEFORE ME THIS f ? 4.1. DAY OF DU o k— 20 / ? ,
BY (./bah W ►'e-KJO/ WHO IS PERSONALLY KNOWN TOME OR O H
ODUCED . !" L Qr. . C/+ AS IDENTIFICATION.
S NATURE F NOTARY PUBLIC TYPE OR PRJWT NOTARY
10019 COMMISSION NUMBER
(SEAL)
I'
SLCPDSD Revised 04/11/2011 I
=�4µYI� BTq�hi(nA+�•i�AN1EL
' �e��a�jifit'spS�lnsurance