HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT BY
SLude C&O
I, the undersigned, am the owner of the. following described property,
�43ih 6Lo3 -c�O�g � - Z. •2-S1 ar-r,ar . �3-�-sac Q .
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie. County for a FinaLDevel pm nt Permit. In
accepting this Final Development Permit, BP Number % J-T17acknowledge
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.
(Akcl4-Nc_,L r. c cL4, ,
Property Owner Name (Please Print)
�a�
Prdferry Owner Signature Date
STATE OF FLORIDA, COUNTY OF `L I�.�G(
ACKNOWLEDGED BEFORE ME TIES 2_0_1*'_ DAY OF _� (,1,r1 C_ 20 ( -IC4
BY � CLAQG( D e d P 1 ck_ WHO IS PERSONALLY KNOWN TO ME is OR WHO HAS
PRODUCED
OF NOTARY PUBLIC
Z4 2 4 l d COMMISSION NUMBER
L� L e rt S e-- _ AS IDENTIFICATION.
Pa izp_(a 0 e ok
TYPE OR PRINT NOTARY
(SEAL)
a"""••. PAMELA S. CENK
�' 4+ Notary Public -State of Florida
Commission # FF 242410
My Comm. Expires Jul 29, 2019
SLCPDSD Revised 04/11/2011 ���3,��� ;� •`��, Bonded through National Notary Assn.