HomeMy WebLinkAboutFILLED LANDS AFFIDAVIT•
as
ST. LUCIE COUNTY
BUILDING & ZONING
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34962-5652
462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described. property:
d3dg • Gel • o ,'/o • oao•o /,tors SI , 5a +5 3 ., 816ocu 8 ) "aooJcal__�res_l �17/ Su unse �R. �'rP�tre�6 Fi, 3�J9�15
for which I have applied to St. Lucie County for a Final Development Permit. In accepting
this inal 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
drain'! ge 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.
I
Prope6 Owner Name Property Owner Signature Date
H Luca
STATE't?F FLORIDA, COUNTY OF
ACKNOWLEDGED B/E�FORE ME THIS p I _DAY OF 00 .20 O�
BY II L( c,k) WHO RSO�LLYKNOWNME OR WHO HAS PRODUCED
I� GLi It, 4�ivw 7 AS IDENTIFICATION.
;rt tioL J VaA4U w tie' T Pc-eo—
OF NOTARY TYPE OR PRINT NAME OF NOTARY
PUBLIC TITLE ICJ COMMISSION NUMBER (SEAL)
Denise 3. Parker
. MYCOMMISSION#1 DD130919 EXPIRES
:,T September 1, 2006
BONDED THRUTROY FAIN INSURANCE INC