HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
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FILLED LAND AFFIDAVIT ��ye �8®
004
I, the undersigned, am the owner of the following described property,
(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.
Ta s gS�=
Property Owner Name (Please Print)
10 �0
Property O er Signature Date
STATE OF FLORIDA, COUNTY OF Sk WG
ACKNOWLEDGED BEFORE
nMETHIS 10 DAY OFO �/a 20 16
,
BY i Q 1 � n ou sr. % WHO IS PERSONALLY KNOWN TO ME CEI) OR WHO HAS
PRODUCED Fl- Y � ,9 12-02S AS IDENTIFICATION.
NATURE OF NOTAPUYPUSLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
Ardel Campbell
NOTARY PUBLIC
STATE OF FLORIDA
Comm# FF233777
SLCPDSD Revised 04/11/2011 Expires 5/21/2019