HomeMy WebLinkAboutFILLED LANDS AFFIDAVITN_J
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
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 Fal evelopment Permit. In
accepting this Final Development Permit, BP Number I iI 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 properly,
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 Otvner Name (Please Print)
Owner Signature
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Date
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TTE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS.
tiY� DAY OF , 20
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BY W(7S�QV 1� WHO IS PERSONAL OWN TO ME OR WHO HAS
ED
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SIGNATURE OF NOTARY PUBLIC
COMMISSION NUMBER
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SLCPDSD Revised 08/24/2010
AS IDENTIFICATION.
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PRINT NOTARY
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