HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, Fl, 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
1, the undersigned, am the owner of the following described property,
2,4 2-1-19 ® 1,eD<0'PT,600— 7
(Parcel ld#/L.egal 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.
Property Owner Name (Please Print)
Propert.r ivZture Itate
STATE OF FLORIDA, COUNTY 0
ACKftLEDGED' o RAME THIS— DAY 20
BY TWHO IS P RS ALLY KNO E OR WHO HAS
P DUCED A AS IDENTIFICATION.
In o,
SI TURE OF NOTARY PUBLIC TYPEOR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011 RACHEL ANN VOSSEN
-N�- Notary. Public - State of Florida]
Commission I GG 189932
M Comm. ExPiies Apr 16.2022
y
ry s,
��tncled through National Notary Assn. Assn.