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
I, the undersigned, am the owner of the following described property,
SCANNED
BY
St. Lucie County
�l/509`9oS 6ya3-000-a A I<emnnOAP 12-cmP✓tc�L'�e s le a3
(Parcel ld#/Legaldescriptiou/Address) 138ai S•2n�.c � 2.'ue21y . �Lo! 5Z3
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.
Soh r1 T C iane_k e_4-f #
Property Owner Name (Please Print
041A /2-/7- le
operty er Signature Date
STATE OF FLORIDA, COUNTY OF _S-r lucte
ACKNOWLEDGED BEFORE ME THIS � DAYOF DEGL'MBf1t .20 AP
BY VJ AW t4 NCIIET71 WHO IS PERSONALLY KNOWN TO ME Eb OR WHO HAS
PRODUCED P/LIVEP—T 1, ja&SIF AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC
FF 913z* o COMMISSION NUMBER
SLCPDSD Revised 04/112011
Qo'Nos" M h64raN
TYPE OR PRINT NOTARY
DONALD M.,ll�9N
jc�; Notary Public - Si"atte cl Florlda
. • Commission # FF 913240
?;•` My Comm. Expires Sep 20.2019
••uo�� BoorledtIMMIGhNall0nall Notary Assn.