HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building &!Code Regulations Division
2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652
(772) 462-1553
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FILLED LAND AFFIDAVIT
I
I, the undersigned, am the owner of the following described property,
q3 o-UD2-00 0
(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.
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 N6T be adversely affected.
Ig this permit for the development of this property,
nor liable to provide for, or maintain in any form,
i which will not adversely affect the immediate
Date
ACKNOWLEDGED BEFORE ME THIS DAY OF J-V 20
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BY I U— R!L' e-7 L7 WHO IS PERSONALLY KNOWN TO ME C v OR WHO HAS
PRODUCED AS IDENTIFICATION.
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SIGNATORE OF NOTARY PUBLIC ! TYPE OR PRINT NOTARY
iON NUMBER
CRYSTAL DAWN MO oRE (SEAL)
MY COMMISSION # GG066605
'•• ;o;EXPIRES January 26, 2021
SLCPDSD Revised 04/11/2011