HomeMy WebLinkAboutFILLED LAND AFFIDAVIT--� ij.,— ---- —
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIAAVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 -
FILLED LANDS AFFIDAVIT
SCANNED
BY
St. Lucie County
I, the undersigned, am the owner of the fojlowing described property,/4/d 7-3/3.4D /s-eeo -
SySa -S Alxj e T a-
7 3 c/ 41A A / / f <,uil 1
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)
Property Owner Sigrtfiture Date
STATE OF FLORIDA, COUNTY OF C4 1AL1 e-4-e--
ACKNOWLEDGED 13E^F,O,RjgQ�
�E METHIS / � DAY OF
BY �,LI��� �`'' 441$pERSONALLY KNOWN TO ME(/) ORWHOHAS
AS IDENTIFICATION.
TYPE OR PRINT NOTARY
(SEAL)
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