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FILLED LAND AFIDAVIT
�JL�E COG ST. LUCIE COUNTY c BUILDING &ZONING ?!.. 236U VIRGINIA AVENUE FORT PIERCE, FL 349825652 ��ORIOP 462-1553 F FILLED LANDS AFFIDAVIT SCANNEE) 1, the undersigned, am the owner of the following described property_ 3qa1-311- 0DDa-D©D--9 for which I have applied to St. Lucie County for a Final Development Permit. In accepting this Final Development Permit, BP Number p':j pa 1 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 STATE OF FLORIDA. COUNTY O Property Owner Signature Date BEFORE ME THIS .�DAY OF NOTARY PUBLIC TITLE 11- 20 —D WHO IS PERSONALLY KNOWN TOME OR WHO HAS PRODUCED AS IDENTIFICATION. / d�t t TYPE OR PRINT NAME OF NOTARY ,•;„�: ••,,, LORIEAOERSIEMEIER �A' � MY COMMISSION � DD 514317 "` EXPIRES:Eebruary14,2010 >:i+s COMMISSION NUMBER (SEAL)