HomeMy WebLinkAboutFILLED LAND AFFIDAVITN
1, the undersigned, am the o�n(
3427-111-0002—
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ST. LUCIE COUNTY
BUILDING & ZONING
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
772-462-1553
FILLED LANI[)S AFFIDAVIT
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of the following described property: N
RECEIvED
APR �,5 7ole
Permitting Department
St. Lucie County
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 propert�' 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 WIL�, 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 �mmediate community.
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Property Owner Name
STATE OF FLORIDA, COUNTY Of�
Property Owner Signature Date
1 9 b
ACKNOWLEDGED BEFORE ME THIS Q-3 DAY OF APle I C- 20
By 01.4-nMEW WHO IS PERSONALLY KNOWN TOME OR WHO HAS PRODUCED
AS [IDENTIFICATION.
SIGNATURE OF NOTARY
NOTARY PLLB—LICTITLE
D 6 40-ni Y
TYPE OR PRINT NAME OF NOTARY
COMMISSION NUMBER
My COMISSION # GG 030145
EXPIRES: October 2, 2020
Bonded Thru Notary Public Underwriters
DOW) HYANN BASKIN
(SEAL)