HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
- Building & Co,de Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
40;0.j-
004
I, the undersigned, am the owner of the following described property,
(Parcel Id#/Legal description/Address)
1
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..
L04
P' b,azG 1
Property Owner Name (Please Print)
n
Propert r ignature ate
STATE OF FLORIDA, COUNTY O LOL
t
M%-im
SLCPDSD Revised 04/11/201 1
COMMISSION NUMBER
III Him, I
(SEAL)
20,
OR WHO HAS
AS IDENTIFICATION.
RACHEL ANN VOSSEN
:,,��'.;F.,•
.^ ,•• -°-
Notary Public -State of Florida
:y
Commission, GG 189932
'••.!t" r
My Comm. Expifes Apr 16, 2022
Bonded through National Notary Assn.