HomeMy WebLinkAboutFILLED LAND AFFIDAVIT,
SCANNED
BY
5 e IL-adn (county
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 fo
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(Parcel Id#/Legal description/Address)
described property,
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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.
M
roe ame (Please Print)
- 12
ro rty Owner Signature Date
STATE OF FLORIDA, COUNTY OF ! ! l / % i v
ACKNOWLEDGED BEFORE ME THIS DAY OF 20 / ✓ ,
ByAll-V WHO IS P SO ALLY KNOWN TOME OR WHO HAS
IDUCLED AS IDENTIFICATI
ON.
9-- /
SIGNATURE OF O ARY PUBLIC TYPE OR PRINT NOT
COMMISSION NUMBER
NANCY MANULI MILANO (SEAL)
="*= MY COMMISSION # DD947707
EXPIRES December 19, 2013
SLCPDSD Revised 08/24/407I398-0153 F1oddeNofery$0rvke,o0m