HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553 -
FILLED LANDS AFFIDAVIT
SCABNYNED
I, the undersigned, am the owner of the following described property, Cie COUr
3� 1 �i1i l9i�Ci� -y]b u �11� ItS i SJl
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.
YIO
Property Owner Name ease Print)
`Dnao4 fo �f aa i� iu ,II
Property Owner SignatuM Date
STATE OF FLORIDA. COUNTY OS tUU1L �
ACKNOWLE OED BEFORE ME THIS_ DAY OF(�l'iY'll� .201y
Bye 1 \Id OI Ci' \VK q a • WHO IS PERSONALLY KNOWN TO ME_ OR WHO HAS
3ION NUMBER
TAMMYLYNNDUGUAY (SEAL)
x MY COMMISSION 8EE207632
EXPIRES: June12,2P6
Nl�rEOF R�'°e Bonded TNu Budget Notary Services
SLCPDSD Revised 0824/2010
AS IDENTIFICATION.
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