HomeMy WebLinkAboutFILLED LAND AFFIDAVITST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 349825652
561462-1553
FILLED LANDS AFFIDAVIT
SCANNED
St. Luce coin
I, the undersigned, am the owner of the following described property, / Z o/ O
�/ r/�i./l�✓�z.rl.0 m//-iJ , i�i2Thi)aLc'c%� � ��� 3 � i S /!
(tax ID/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 . 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 roperty Owner Date
(Print) (Signature)
STATE OF FLORIDA, COUNTY OF CX At[
SWORN T(2 ND SUBSCRIBED BEFORE ME THIS
BY J D�
SIGNATURE OF NOTARY
NOTARY PUBLIC TITLE
IS PERSONALLY KNOWN TO MM)= OR WHO HAS PRODUCED
IDENTIFICATION.
TYPE OR PRINT NAME OF
COMMISSION
v Ap
+F ,n THOMAS E. WEISS
oy MY COMMISSION # DD 146M
-'�e0FII EXPIRES: Septemher23,2006
IE0p3NOTARY FLNW"90Mw&Bw1ckM I=
SLCCDV FORM NO.: 011-00