HomeMy WebLinkAboutFILLED LAND AFFIDAVITo PLANNING & DEVELOPMENT SERVICES DEPARTMENT
. Building & Code Regulations Division
y 2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
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FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described,property, .
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ifs L13 -// ,LG% io;f7 o-C- 1164/7- 1116
(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.
Property Owner Name (Please Print
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PropFowner Signat&D Date
STATE OF FLORIDA, COUNTY OiA
ACKNOWLEDGED BEFORE ME THIS c;� 1 D Y , 20� P
BY �/G 6 J T1 —4 � IS PERSONALLY KNOWN TO ME Q) OR WHO HAS
PRODUCED AS IDENTIFICATION.
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SIGNATURE OF NOWY PUBLIC TYP PRINT NOTARY
v
COMMISSION NUMBER
SLCPIDSD Revised 04/11/2011
(SEAL)
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AUDREY B. HUMPHRE
*� 17477
y 0() S SMarch 6, 20192
7hru Notary Public Underwriters
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