HomeMy WebLinkAboutFILLED LAND AFFIDAVITa 01
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PLANNING & DEVELOPMENT -SERVICE$ DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGIMA AVENUE
FORT PIERCE, FL 3082 5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner_ofthe following described property,
Iditegal descciplion/Address)
for which I have applied to
accepting this Final Develop
that as owner of the abov
7.04.01(D), St. Lucie County ]
adequate drainage so. that the
I further acknowledge that in
St. Lucie County is neither o
adequate drainage off my p
community.
F.�
1�
U
t. Lucie County for a Final Development Permit. In
nt Permit, BP Number �I acknowledge
described property, and in accordance with Section
rid. Development Code, I shall be responsible for assuring
(mediate community WILL NOT be adversely affected.
anting this permit for the development of this property,
ged nor liable to provide for, or maintain. in any form,
perty which will not adversely affect the - immediate
/ 15
Date
STATE OF FLORwA, COUNTY OF iM IFY2TSN
ACKNOWLEDGED -BEFORE ME THIS i DAY OF
BY WHO IS PERSONALLY KNDWN TO ME' OR WHO HAS
PRODWED AS IDENTIFICATION.
SIGVATURE OF NOTAItY PUBLIC _ ;., N I (MISSION # EE 860008
EXPIRES: Apni 20, 2017
COMM[SSIONNUMBER 'a' �` p�'�y„ Bonded ThNNotary PeblkUndenxriters
(SEAL)
SLCPDSD Revised 08/24/2010