HomeMy WebLinkAboutFILLED LAND AFFIDAVITiCANNED RECEIVED
BY
St Lucie COuniV MUNI. JAN 2 4 2018
I �bl�lo County, Permitting
PLANNING & DEVELOPMENT SERVICES DEPARTME DT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property, p�
34b2- fol O — O ZLb- OOD - �( � pj,%,. (�Iuc�Y Es JoS l In 1 0'lj D+ (C %% ' �OT 3S
(Parcel Id#/Legil description/Address)
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.
,0C �,' •� J�H fir` �u P4s
Prop rty Owner Name (Please Print
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
AC OWLEDGED BEFORE THIS DAY OF \ 1R N , 20�
j(2 1 , y WHO IS PERSONALLY KNOWN TOME OR WHO HAS
PRODUCED
AS IDENTIFICATION.
SIGNATURE OF NOTARY PU13LIC TYPE OR PRINT NOTARY
COMMISSION NUMBER """""� KA R E N S. N I E L S E N
Commission # FF 115637
My Comrr(SEW Expires
_ �y '��i♦FOFFI°0.�June 12. 2018
iF!
SLCPDSD Revised 08/24/2010