HomeMy WebLinkAboutFILLED LAND AFFIDAVITSST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
23M VIRGINIA AVENUE
FORT PIERCE. FL 34992-%52
561-462-1553
FILLED LANDS AFFIDAVIT
SCANNED
BY
St. Lucie County
I, the undersigned, am the owner of the follow' n described property, Z07 6, Bto�
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(tax 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.
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Property Owner Property Owner Date
(Print) (Signature)
AdE,/ PAQOdT
STATE OF FLORIDA, COUNTY OF Sr
SWORN
/T'O AND SUBSCRIBED BEFORE ME THIS ZF7 DAY OF �Url/E . 20 O/ ,
BY K E1Y 10 R"T WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION. ,/
/&C-0A y . /EiT .a rN,, (se
)ITURE OF NOTARY TYPE OR PRINT NAME OF NOTARY aJ`S -4 4, � P A. PgOBE
COMMISSION NUMBER nu ,` AtlanliBBaodigg Co Inc,
NOTARY PUBLIC TITLE GG9 /5B7 ,,oFfl'. Thra
SLCCDV FORM NO.: 011-00