HomeMy WebLinkAboutFILLED LAND AFFIDAVITSCANNED
BY �.
��. Lude CCU D
_.PLANNING & DEVELOPM ENri SERWCES DEPARTII�dENT--_ .. .. _ .
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
33�a aa-- aoo -ado - G
(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 \ 5 dA - O \ 5 3 , 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.
',mot (VC 4�
Property Owner Name (Please Print)
Property.Owner Signature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF Fe4 N14yc-t 20
BY lC� h/� f /t T3 rf r 2 WHO IS PERSONALLY KNOWN TO ME (V) OR WHO HAS
PRODUCED
(�'. A' u "
SIGATURE OF NOTARY PUBLIC
Ej- 114M' COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION.
,14 /`'IAdZ (J7 2Bd1
TYPE OR PRINT NOTARY
•ti:�s'�AIAJJNA MARIE GREEN
Commission # FF 112005
a: Expires August-- 201 ame
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