HomeMy WebLinkAboutFILLED LAND AFFIDAVITK
COUNTY ,.I
F •L .0�. R' ° 6 b' A -
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,
(Parcel Id#/Legal description/Address) ^ q S R f qrn t/ �,J k W61 VM �q ff3
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.
L��7v�
Property er Name (Please Print
op rty Owner Signature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF I 20 /2
BY A 7- 4 WHO PERSONALLY K TO ME () OR WHO HAS
PRODUCED
OF NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
•1�+tv � ERfGCOWN (SEAL)
` ? MY COM.Mr10N # FF 055938
EXPIRES: december 15, 2017
�� Bonded Thiu Notary Public Underwriters
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION.