HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
6718ANNE� d
SCANNED
FORT PIERCE, -FL 34982-5652
BY
(772)462-I553,-'
`t. Lucie Counbr
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property, 4 , 12^231-e004-6*0 S"
C OCeotil o.( JyNSPAj
description/Address) PeFI r2-3?L!
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
7.04.0l(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community VO LL 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.
Pl P'Cf'v �y11 � g i u t '`
Property owner Name (Please Print)
. ;Lo i-3
Pr a(y Owner Sign4§P6 Dat
STATE OF FLORIDA, COUNTY OF 1 h/hkf ) I VCR
ACKNOWLE7DGEDBEFOREMETHIS �DAYOF / ]i 202/ ,
BY I�cYzRY CH(,1jE WHO IS PERSONALLY KNOWN TOME_ORWHO HAS
COMIMISS10N NUMBER
SLCPDSD Revised OM42010
AS IDENTIFICATION.
TYPE Q NOTWhWM
* MYCOMMISSION A EE 163410
EXPIRES: April 30,2016
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