HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-I553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
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(Parcel
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SCANNED
St. Luciey
County
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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.
LlSA /2se
Proper t OwnerName (PleasePrint)
roperty Owner Signature ate
STATE OF FLORIDA, COUNTY OF S.r ZLI+ Lr
ACKNOWLEDGED BEFORE METHLS DAY OF P'I. .20-�?—
BY _4 WHO IS PERSONALLY KNOWN TO ME (a OR WHO HAS
PRODUCED / AS IDENTIFICATION.
"ATORE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL) JOWEWaJB
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SLCPDSD Revised 04/I I/20I1
13