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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
-2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
RECEIVE
FILLED LAND AFFIDAVIT
JUN 2 5 ?�?9
ST, LUCfo County, Pcr-mluing
I, the undersigned, am the owner of the following described property,
1 04 CSCC�
(Parcel Id#/Legal description/.
Q- (DM-01�P--
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number 14P " O 5S 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.
v Im4aP, iq Mo,,,- V
Property Owner Name (Please Print)
J(, t4, Q�lL�
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF • 1' V c
ACKNOWLEDGED BEFORE ME THIS a5 DAY OF J J �� 20 1 `�
BY'VNdk f is VN4bi%
PRODUCED
WHO IS PERSONALLY KNOWN TO ME C_) OR WHO HAS
L' 1� L AS IDENTIFICATION.
�SIGNAT=OF�NOY PUBLIC�
COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
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TYPE OR PRINT NOTARY
DEANNA?AAR!EGIVENS
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