HomeMy WebLinkAboutFILLED LAND AFFIDAVIT9 W V- 0/ -7c-)L-
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PLANNING & 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, .
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 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 immediate
community.
Property Owner Name (PI se Print)
i� ;�►.. �� 1.
Property Owner Signature D to
STATE OF FLORIDA, COUNTY OF��'-���
ACKNOWLEDGED BEFORE ME THIS DAY OF I!� �/20
BY ,G/K-�v� Ael�/1'�-A14tJWHO IS PERSONALLY KNOWN TO ME OR WHO HAS
SIGNATURE OF NOTARY PUBLIC
;�� �O " URCOMMISSION NUMBER
SLCPDSD Revised 08/24/2010
AS IDENTIFICATION.
TYPE OR PRINT NOTARY
(SEAL)
Y p�AMANTHA. WOODS
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`��•, Notay Public - State of Florida
'• . My Comm,•Expjres Aug 2, 2017.
FF: CoA M181jon FF 038406
Band/O 0"0 NaftW Notary Asm