HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
FORTVIRGINIA AU
PIERCE, FL.349V 82 5652 SCANNED
(772) 462-1553 BY
St. Lucie County
FILLED LAND AFFIDAVIT -- —
I, the undersigned, am the owner of the following described property,
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Devel p ent Permit. In
accepting this Final Development Permit, BP Number lei I acknowledge
that as owner of the above described property, and in accord ce 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.
Property�wner Name (Please Print)
A , /%
PropertyDftecBgnature
STATE OF FLORIDA, COUNTY OFs� t- �
Date
ACKNOWLEDGED BEFORE ME THIS S DAY OF Z) t C .20-�.
By S�'•�G\ LUa. �`Jnn�q WHO IS PERSONALLY KNOWN TO ME/_)OR WHO HAS
PRODUCED L-- AS IDENTIFICATION.
SIGNA]TUREOFNOTARY PUBLIC
adG\ COMMISSION NUMBER
SLCPDSD Revised 04/112011
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TYPE OR PRINT NOTARY
GNENS
MY COMMISSION A CO072023
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