HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division � ANV�1F—F,'
gy
2300 ViRGINIA AVENUE B
FORT PIERCE. FL 34982-5652 �a
(772) 462-1»3 st Lucie County,
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
t-IS
(Parcel W/Legal des %iptii
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.
k L- Sc,�j (e,l
Property Owner Name (Please Print)
ope y Owner Signature Date
STATE OF FLORIDA, COUNTY OF�GLU C ( P_
ACKNnOnW_LEDGED BEFORE IME THIDAY OF JO(A ` 20 t `�
BY IV 11J1d(�1r-0I C h I I QI'I- e' WIlp IS PERSONALLY KNOWN TO ME ] OR WI-10 HAS
PRODUCED —Y' Y't li�l� LC�j�S 2i AS IDIi911FICATION.
►�� �//f /1 • 1 / 1I�I AM
���� •1000610
COMMISSION NUMBER
(SEAL)
tppv
DINAH G CUSHMAN
o :
Notary Public - State ofFlorida
MOP
Commission# GG076851
P3-My
SLCPDSD Revised 04/11/2011 nii•
Comm. Expires Feb 28, 2021
BondedthroughNadonafttaryAssn.