HomeMy WebLinkAboutFILLED LAND AFFIDAVIT- s 1
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- PLANNING & DEVELOPMENT -SERVICES DEPARTMENT
Building & Code Regulations Division
_ 2300 VIRGINIA AVENUE
F07. PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
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I, the undersigned, am the owner of the following described property,
(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.
Property Owner Name (Please Print)
Owner
STATE OF FLORIDA, COUNTY OF
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,
which will not adversely affect the immediate
W
Date
BEFORE ME THIS _y DAY OF 20 / • ,
yh J J `1VHO IS PERSONALLY KNOWN TO ME Q OR WHO HAS
PRODUCED ♦ IyN •
NUMBER
SLCPDSD Revised 04/11/2011
PRINT NOTARY
(SEAL)
AS IDENTIFICATION.
- 41U. M %Po #q 91
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