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 Sc
St 4Uc/@Co�O
. ntk
I, the undersigned, am the owner of the following described property,
&V01) '505-0C)a2-mb-4/b lAF f V0. "CJI�1OkA 66-'S'1A
(Parcel Id#/Legal 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.
� t1 wk1 ku1n CA-y-.owg
Pypperty Owner Name (Please Print)
2-7 - l�
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF ,
ACKNOWLEDGED BEFORE ME THIS DAY OF / ^ 20
BY mM i A fV !/Wiio IS PERSONALLY KNOWN TO ME (lam OR WHO HAS
PRODUCED
IDENTIFICATION.
t5-'qu Aoq
lanaec�w Wo 9 M) A 9 9 1 Z 10 U911 OWA
COMMISSION NUMBER
SLCPDSD Revised 04/112011
(SEAL)
SF30
'119er+rt'M1eM