HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINU AVENUE
FORT PIMCE, FL 34982-5652
(772)462-1553 Welve
FILLED LAND AFFIDAVIT MAY 21 2glg
Permitting Department
St. Lucie County
I, the undersigned, am the owner of the following described property, SCANNED
BY
10648 Pine Cone Lane, fort Pierce, florida St. Lucie County
(Parcel IM/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 _ p� y[ 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.
Nancy Johnson
Property Owner Name (Piease Print)
✓ y
Property OWner Sign ur Date
STATE OF FLORIDA, COUNTY OF � 1 CA �-
/ ACKN WLFIXIED BEFCIREMErBIS 1qP DAY OF
BY ! ftt.Aj � h ✓1 WTIO IS PERSONALLY KNowN, To ME. ) OR WHO HAS
COMMISSION NUMBER
SLCPDSD Revised 041112011
AS IDLNTIFICATION.
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TYPE OR PRTNr NOTARY
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Commis9on a GG 104331
My Comm Expires Sep 9, 1011