HomeMy WebLinkAboutFILLED LAND AFFIDAVIT5
SCANNE) MAW'
BY
St LIIt;IG' COUnfPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 J I I N 0 J L r I o
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described propertyjVD,Z 406.00#1-!0d
qc, 7 p4Imp-t-M at- prP,eTee F/
`f—I 7 , a—, 1 ") ( .)Pl /l•,06,4 f Z/XJ/17/ 5/6
Id#/Legal description/
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
communiy.
Prop/rty Owner Name (Pleake PrdIF n
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF^C
ACKNOWLEDGED BEFORE ME THIS ( ` DAY OF L —, 20 —,
BY2lNlJ �� (4it) a �JG' Q� I IS PERSONALLY KNOWN TO ME OR WI40 HAS
AS IDENTIFICATION.
sr ��
OF NOTAR PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
�•.;',P��l,�, S':-1LRR1FElili:'lids
(SEAL) '' tR COM ViISSIM I FF 1G0'i 0
EXPIRES: `,larch 11, 2015
BondedThru Buegefl%tary services
SLCPDSD Revised 08/24/2010