HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
SCA*SL)
FILLED LAND AFMAVIT tu By I
Cie catjnty
1, the undersigned, am the owner of the following described property,
5
(Pared ld#/Legal
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Fmal Development Permit, BP Number 1c1Qi-n--kc1l- I acknowledge
that as owner of the above described property, and in accordance witli Section
7.04.01(l)), St. Lucie County Land Development Code, I shall beresponsible 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.
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Property Owner Name (Please Print)
ro
Property Owner Signature Date
STATE OF FLORIDA- COUNTY
ACKNOWLEI)GED BEFORE ME THIS DAY OF 2o-L7—,
By Oliq)u' Aaule/D Fl/ WHO IS PERSONALLY KNOWN TO ME (ElOR WHO HAS
PRnr)trrF:n -DRI(le12 'z I 1.rF-fJri= iL
L 15 E Z.4 VIC,,KIE7
TYPE OR PRINT NOTARY
OASHSSION NUMBER
Lise Lavigne - Commissionev
by virtue of rn� office as (SEAL)
Deputy lerk
TownsUp of tiortn Gengarry
SLCPDSD Revi�d 04111/2011