HomeMy WebLinkAboutFILLED LAND AFFIDAVIT(r _
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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
12300 VIRGINIA AVENUE
FORT PIERCE, FI, 34982-5652
(772) 462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
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(Parcel Id#/Legal description/Address)' I
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 (Please Print)
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Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF Si- "6Q-
ACKNOWLEDGED BEFORE ME THIS DAY OF 201
]Q &J ^y WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
POOKCF AS IDENTIFICATION.
TYPE OR PRINT NOTARY 1
COMMISSION NUMBER DAVID N. KNEPPER
Commiss 995518
Expires September 25, 2014
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SLCPDSD Revised 08/24/2010