HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGHVIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 RECEIVED
FILLED LAND AFFIDAVIT MAY 0 S 2919
5T, (,ucle County, Permitting
SCANNED
I, the undersigned, am the owner of the following described property, BY
3415-504-0035-000-4 / 6521 Las Palmas Way Port St Lucie, FL 34952 St. Lucie County
(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.
OHoP-W VOT I L-
Pr/e(Pleaseprint)� j 1 5 I �2 a
Property�Owner Signature Date
STATE OF FLORIDA, COUNTY OF 1 �V CA
ACK/N'OI WLED BE OREMETHIS I
BY l � U +i P
DAY OF, A A
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WN TO ME fl " Il OR WHO HAS
WHO IS PERSONALLY
PRODUCED
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AS IDENTIFICATION.
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SIGNATURE OF NOTARY PUBLIC
TYPE OR PRINT NOTARY
G 6 L" ' S {' 6
COMM14SSION NUMBER
(SEAL)
SLCPDSD ReAwd 04111t2011
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PEMS0.0NE HA'1 0ublic State A.Floridaission c GG 259a6a
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