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
I, the undersigned; am the owner of the following described property;
SLI02. o7 in oo S /,at
(Parcel Id#/Legal description/Address)
3 cdf 10 d�k 22
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.
Property Ogvner Name (Pie Print
Prope Owner Si ature /
STATE OF FLORIDA, COUNTY OF
9i9.4-
Date
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
��,
BY II I � T AZ/Z4-WHO IS PERSONALLY KNOWN TO ME da OR WHO HAS
PRODUCED
COMMISSION NUMBER
SLCPDSD Revised 04/1112011
OR PRINT
(SEAL)
AS IDENTIFICATION.
AUDREY B. HUMPHREY
SSION k FF 1747rch2019
72MCOlMMI'bUrwoersBoed Thru Notary Pundee