HomeMy WebLinkAboutFILLED LAND AFFIDAVITSCANNO
BY
it Ludy Cam*
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 following described property,
$31 b A--" J tw5 Ay-c 2 3 2,3 ('o 1 O Q 20-a'd Ll
(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 , 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 "imp mediate
community. / t PC;
K6,ro v e S D la i) /►ct 8q S=S
Property Owner Name (Please Pr' t)
A �K'� A-Z/
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF & L ULl e'
ACKNOWLEDGED BEFORE ME THIS DAY OF , 20
BY 'D1 a Un-'&- SS WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUCED AS IDENTIFICATION.
Aqw") -DawnMen-Acid
SI ATURE OF NOTARY PUBLI TYPE OR PRINT NOTARY
1 COMMISSION NUMBER
„..„
4ti.sr Will
DAWN EDENFIELD
W COMMISSION II EE 133 N
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SLCPDSD Revised 08/24/2010