HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
1/510 Z
(Parcel 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 property, 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 WILL NOT be adversely affected.
I further acknowledge that rI 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 immediate
community.
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Property Owner Name (Please
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Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF X 14, G 5��
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ACKNOWLEDGED BEFORE ME THIS r DAY OF
BY \L_X �\ �ERSONALLY KNOWN TO ME OR WHO HAS
j "NOTARY
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VC
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COMMISSION NUMBER
FW 11 AM10co".1610rill
`o-'a,,�e% i CSE� DAWN MILONE
P, ' Notary �'ublic - State of Florida
's My Comm. Expires Mar 22, 2017
Commission # EE 877571
6 Bonded Through National Notary Assn.
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SLCPDSD Revised 08/24/2010