HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FOI PIERCE, FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
`1005
(Parcel Id#/Legal description/Address)
for which I have applied to St.
accepting this Final Development
that as owner of the above de
7.04.01(D), St. Lucie County Land
adequate drainage so that the imm
I further acknowledge that in gran
St. Lucie County is neither oblige
adequate drainage off my prope
community.
J�ET
Property Owner Name (Ple se Print)
Owner
STATE OF FLORIDA, COUNTY OF.
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GGA NNED
BY
8t LUr'jP r.0 In
L? �PK !bS L.0rt Qg
Icie County for a Final Development Permit. In
-rmit, BP Number , I acknowledge
ribed property, and in accordance with Section
evelopment Code, I shall be responsible for assuring
iate community WILL NOT be adversely affected.
Ig this permit for the development of this property,
nor liable to provide for, or maintain in any form,
f which will not adversely affect the immediate
Date
v n n�
ACKNOWLEDGED BEFORE�,
ORME THIS �I DAY OF JC// / 20
BY BE !—WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUCED
SIGNATURE OF NOTARY PUBRIC
EE C OMMISSION NUMBER
AS IDENTIFICATION.
TYPE OR PRINT NOTARY
VP�a,� CONNIE MCIVER
_.
`�N406lic - State of Florida
• . o My Comm: Expires Jul 29, 2016
Commission N EE 209535
Bonded Through National Notary Assn.
•�,nma•
SLCPDSD Revised 08/24/2010
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