HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE SCANNED
FORT PIERCE, FL 34982-5652 BY
(772) 462-1553 'StLuriprnfir
FILLED LAND A-FFIDA
AUG 0 8 11
ST. Lucie County, Permitting
I, the undersigned, am the owner of the following described property,
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(Parcel Id#/Legal description/Address) AND 16 (Xkp'3511
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67111 r&LcjjMh*j jJv, Fvf--r we�wc- f:', :g to s-2-
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 flirther acknowledge that in granting this perrnit 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.
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Property Owner Name (PleasePrint)
Pf'opirty Owner Signi5 Ddte
P�-�
STATE OF FLORIDA, COUNTY OF ArLLJC�Q-�
ACKNOWLEDGED BEFORE ME THIS Co DAY OF A�J� 20
By G�cfNz�A WHO IS PERSONALLY KNOWN TO ME &OR WHO HAS
0-135-EPOMMISSION NDMBER
SLCPDSD Revi�d 04111/2011
AS IDENTIFICATION.
TYPE OR PRINT NOTARY
KATRINA KLL)CINEC
Y COMMISSION 0 GG 033730
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, EXPms:septm�26.21)20
(SEAL)
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