HomeMy WebLinkAboutFILLED LAND AFFIDAVITI�.:.. RECEIVED
OCT 19 2018
ST. Lucie County, Permitting
PLANNING & DEVELOPMENT SERVICES DEPARTM
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 SCANNED
BY
FILLED LANDS AFFIDAVIT St Lucie County
I, the undersigned, am the owner of the toll wing described property,
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(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 Owner Name (Please Print)
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Property Owner Signature Die
STATE OF FLORIDA, COUNTY OF
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' ACK /OWnLEDGED BEFORE ME THIS DAY
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BYE \ /Lllrx�� /'�;! U WHO IS PERSONALLY KNOWN TO ME
OR WHO HAS
PRODUCED
AS IDENTIFICATIO .
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SI ATURE(OkNOTAWPURLIC TYPE OR PRINT NOTARY
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COMMISSION NUMBER
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(SEAL)
SHERRI FEHLMAN
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SLCPDSD Revised 08/24/2010 1 e'*` Ex0res March
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