HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGE41A AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT SCANNED
®F`rslm4t
I, the undersigned, am the owner of the following described property,
i 5o 5 At SAcvd r{4s5 W/4y W54-n doe4<
P40 r — 8vrrV✓BVSW U'i//A4e-- t1W/i-5VA #2"1'Y- Z'9a0
(Parcel 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.
L 1j-AAy 1 &Pn171 : M 0.55IW67EW',
Proper er Name (Plea a Print)
Property Owner Signature Date
N, 11
STATE OESLOAR)A, COUNTY OF
ACKNOWLEDGED BEFORE NE
TTHIS / DAY OF
/
BY ``'' 7 /� -'��1rc�Ssi iLg a WHO/IS PERSONALLY KNOWN TO ME C❑� OR WHO HAS
PRODUCED.40h6 Ind 0 �O f y6 f l�� N 9 7 4p9/-vlayAS IDENTIFICATION.
4/ llsk"�
TYPE OR PRINT NOTARY
CONMSSION NUMBER
LORI E. HILSHEIMER (SEAL)
NOTARY PUBLIC OF NEW JERSEY
My Commission Expires February 9, 20Z3
SLCPDSD Revised 04/112011