HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
` Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 SCANNED
RECEIVED
FILLED LAND AFFIDAVIT St tucle co
MAR Z 3 2018 ��
ST. Lucie County, PerMittifig
I, the undersigned, am the owner i f the following described property,
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�-3lo- Oo- oo[�-�( /6t6 526t-h i4o:7 5y20D0CN,3�-YV5cwti
(Parcel Id#/Legal description/
for which I have applied to
accepting this Final Developer.
that as owner of the above
7.04.01(D), St. Lucie County L
adequate drainage so that the i
I further acknowledge that in 1
St. Lucie County is neither of
adequate drainage off my pr
community.
Property Owner Name (Please Print
Property
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS
BY: �-PfirCl/ B M l (( IP r
Lucie County for a Final Development Permit. In
Permit, BP Number , I acknowledge
scribed property, and in accordance with Section
Development Code, I shall be responsible for assuring
ediate community WILL NOT be adversely affected.
Iting this permit for the development of this property,
;d nor liable to provide for, or maintain in any form,
rty which will not adversely affect the immediate
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3.22-(8
Date
_ DAY OF ��, 20 I0 ,
WHO IS PERSONALLY KNOWN TO ME (LJi OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF111NOT Y PUBLIC TYPE OR PRINT NOTARY
a 4L�OMMISSION NUMBER
(SEAL)
;N.vr%i,
SLCPDSD Revised 04/11/2011
M011
DONNAM.CAILLIER
Notary Public - State of Florida
Commissionq GG 148944
My Comm Expires Feb1,2022
�Bonded through National Notary Assn.