HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 A AVENUE
FORT PIERCE,
FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
JUN 0 6 2019
ST, Lucie County, Permitting
BY
I, the undersigned, am the owner of the following described property, St. Lucie County
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.
Property Owner Name (Pleas Print)
PC'k 51A 1 t3
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF MA-0?;P'10'%)
ACKNOWLEDGED BEFORE ME THIS DAY OF 1�7'¢f 20 / 9
BY Ljw,%9 6"�AN60 WHO IS PERSONALLY KNOWN TOME d2 OR WHO HAS
PRODUCED rl� AS IDENTIFICATION.
SIGNATURE
rO7F p ARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011
=o J'sy n46
ra Sherry Rao
State of Florida
P• My Commission Expires 04/06/2022
°`r`oPCommission No. GG 199378
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