HomeMy WebLinkAboutFILLED LAND AFFIDAVITIm
FORTi'LER6F 'per .3 8 5552
772 462-1553'
X, the vadmaigned, am the owner of the following described ro erC
p p y Part of 3414-501'-1701� . 000 8erti.oh 26 Town's i 36s' .Range 80E
(Taxw%L;egm descuntion/Adrtroael
for w.fiaalW Ihave applied to.
this F,iI aL'ueie County for a Final Development Pemlit, In accepting
Developmeat•permit RP Number
the above descn"bed property, and in accordance with SectioAa0mO 1 edge that as• owner of
Land Development Cdde, I s3aall be responsible for assuring adequate dkain so that file
iimmedigte co7a7gfamuait5, W2LL 3��3T be adversely affected. I further acknowledge that in
30rJiingttospeFmit'iorthea%velop i rrtoi'this.�toperty,Se.LucieC4uttty'isneather'pbliged
)sor Hai le to Azov fle'for, or•a7airtitaixi in enyfdt3a, ad quata:draia�e'off mq property which
Will not ariwer5ely aiF ect the it7 metlYae 'cbntmiziiity.
Mr�ttheta Lvle y9yrine
Property Owner Name Property Owner
SiVature Date
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AS MNITWMATON.
SYGNA7:tS OF TAi2Y
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g�; TE rylT IiVMMISSION#GG 030145
EXPIRES: October 2, 2020
Sondeo Thnt Notary Public Underaters