HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 RECEIVED
GGAN ED FILLED LAND AFFIDAVIT FEB 01 2018
ST. Lucie County, Permitting
St LUCle CBY ounty
I, the undersigned, am the owner of the following described property,
1-n-T CSC r0-6 I A101
(Parcel Id#/Legal 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.
ATI��
Pro erty Owner Nyfne (Please Print)
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Property Ownef Signature Date
STATE OF FLORIDA, COUNTY OF
_6�.�
ACKNOV,q,EDGED BEFORE ME
THIS I DAY OF T 7A 20Ae
BY `S i.__kU I JL�Z4 WHO IS PERSONALLY KNOWN TO ME (1:1) OR WHO HAS
AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER _
(SEAL)
o°;aYoJa,�.,1<AREN.S. NIElSEN
°= Commission # FF-115637
^a +2
3, oc My Commission Expires
..... i`'� June 12, 2018
SLCPDSD Revised 04/11/2011"" .!.I"'
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