HomeMy WebLinkAboutFILLED LAND AFFIDAVITt' --__,
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
FORT PIERCE, FL 34982-6652
561462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
4309- 3,33-0o04 — 000/t
(tax IDllegal description/address)
for which I have applied to St. Lucie County fof a Fig I Development Permit. In accepting
this Final Development Permit, BP Number Dab to 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 Properly Owner Date
(Print) (Signature)
STATE OF FLORIDA, cbUNTY OF *T Lucie
SWORN TO AND SUBSCRIBED BEFORE ME THIS — — — L5 DAY OF n2yL l . 20dO,
BY C ( C Ul WHO IS PERSONALLY KNOWN TO ME.Qj�j O HA EEpp�
Iv N BLUE
AS IDENTIFICATION. ��{ .- O=1RSS ON # CC615817
c E%PIRES MAR 2Z 2001
,rye BOND®1HR000H
I , � � 'F��1. AAAMICt$QjP.NG Co.INC.
SIG Ti VE OF NOTARY TYPE OR PRINT NAME OF NOTARY
NOTARY PUBLIC TITLE COMMISSION NUMBER
SLCCDV FORM NO.: 011-00