HomeMy WebLinkAboutFILLED LANDS AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE��� �'I^ rIp��
FORT PIERCE, FL 34982-5652 u U
(772) 462-1553 , �
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the followinp, described property,
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1(Parcel Id#/Legal description/Address)
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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.
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Property r Name (PI ase Print)
Property Owner 81ignature Date
I STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE NP THI DAY OF o4a 4 20 e!2—>
BY J`— WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
P ODU ED AS IDENTIFICATION.
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T17PEIOR PRINT NOTARY
COMMISSION NUMBER
SLCPDSD Revised 08/24/2010
(SEAL)
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Commission#CG :7100
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