HomeMy WebLinkAboutFILLED LAND AFFIDAVITI3o� J Dogl ftcp
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2 G 2013
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
FORT PIERCE, FL 3 982- 652 SCANNED
(772)462-1553
St. LuBy
cie county
a
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
description/Address) f� i �, aqq'n
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
7.04.0I(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.
�-TSaW Gnod mok--
Property Owner Name (Please Print)
UaO AnAmo 9c0r3
Property Owner Signature r/ Date
STATE OF FLORIDA, COUNTY OFOQ--lam_
ACKNOWLEDGED
� BEFOU..ME TH(ISS I G DAY OF 20 Z3
aY I T<a Bnts r\q WHO IS PERSONALLY KNOWN TOME /GR WHO HAS
(SEAL)
SLCPDSD Revised 08242010
T10N.