HomeMy WebLinkAboutFILLED LAND AFFIDAVITCOUNTr7A___
F L O R I
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE _
FORT PIERCE, FL 34982-5652 RECEIVED
(772) 462-1553
FILLED LAND AFFIDA Lucie coup
ty, Permitting
I, the undersigned, am the owner of the following described property,
1 1425-701-0031-000-6
(Parcel Id#/Legal description/Address)
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coo,
y
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,
j adequate drainage off my property which will not adversely affect the immediate
community.
RAyn,4 y 7-n V, d o Lk
Property Otffier Name (Please Print)
Propertyi6wner Signature Date
STATE OF FLORIDA, COUNTY OF
j ACKNOWLEDGED BEFORE ME THIS / T DAY OF o.�e_ 20 i D
BYL4Nt7t/ /�1 [ 2 G7 cam/ L WHO IS PERSONALLY KNOWN TO ME ([a —OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
6 O S-b 7 COMMISSION NUMBER
j
(SCAR. HELSETH
MY COMMISSION 0 GG 02=7
N'� EXPIRES:Septem*21.2mk�020
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SLCPDSD Revised 04/11/2011