HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT 80
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I, the undersigned, am the owner of the following described property, t51
QUEENS COVE -UNIT 2- BLK22 LOT E(OR 3669-2438)
(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.
'DAM P&,jKC-L1-
Proper wn ame lease Print)
Property Owner Sign t
e Dat
STATE OF FLORIDA, COUNTY OF ST v G 14
ACKNOWLEDGED BEFORE ME THIS DAY OF V /
BY WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUCED
a- f
SIGNATURE OF NOTARY PUBLIC
COMMISSION NUMBER
AS IDENTIFICATION.
U��A^^t•S �✓�L✓
TYPE OR PRINT NOTARY
JAMS ROUAN -YI
SEAL)
M
MY COMMISSION # GG 006627
EXPIRES: November 4, 2020
e«o Bonded Thru Notary Public Underwriters
Revised 04/11/2011= —