HomeMy WebLinkAboutFILLED LAND AFFIDAVIT�T PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
0-0 2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
SCANNED (772) 462-1553 RECEIVED
BY AUG 0 8 2018
S$ lu, de Cots* FILLED LAND AFFIDAVIT
i• ST, Lucie County, Permitting
I, the undersigned, am the owner of the following described property,
90i - 00 �3-7 - (9C O
(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 immediate
community.
Proper Owner Name lease PH
-----� & � aof
Property Owner Signature Date
STATE OF FLORIDA, COUNTY O &=/
BY \/r l M&O
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PRADUCED
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I ATURE OF N TARY PUBLIC
COMMISSION NUMBER
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SLCPDSD Revised 04/11/2011
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DAY OF
1 IS PE SRO LLNA
TI:PE OR PRINT NOTARY
120 !
ME (_❑) OR WHO HAS
AS IDENTIFICATION.
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RACHEL ANN VCISSEN
Notary Public - State of Florida
Commission d GG 189932
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My Comm. Expires Apr i6, 2022
• Bonded through National Notary Assn.
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