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 S' SC�NN
t dell FO
00,
I, the undersigned, am the owner of the following described property,
34fd --331 -
(Parcel Id#/Legal description/AIL
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.
JO" iM c:Cp,4e t (
Property Owner Name (Ple sa e•Pr nt)—m
, (" .` GA 02• ). P9
Pro •ty Owner Signature Date
STATE OF FLORIDA, COUNTY OF lb'Le— I e`
ACKNOWLEDGED BEFORE �7ME THIS DAY OF 204—
BY Q-0 rn C 0 n r) e) I WHO IS PERSONALLY KNOWN TOME (b OR WHO HAS
PRODUCED �C AS IDENTIFICATION.
w tod `i rib]c y
SIG ATURE OF NO PUBLIC E OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/112011 UOF�9x0 pPFFP� 92
F oMM1s51oN�h6 2O�
reo
acsw �'EiP1PEStaryPpetmOrdarvm�
tJo