HomeMy WebLinkAboutFILLED LAND AFFIDAVITSLCPDSD Revised 04/112011
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 -
RECEIVED
OCT 2 9 2919
ST. Lucie County, Permitting
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
(ParcelId#/Legal
for which I have applied to St. Lucie County for a Fi al Development Permit. In
accepting this Final Development Permit, BP Number 0 -O I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie CountyLand 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.
SCANNED
BY
St. Lucie County
Property Owner Name (Please Print)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEF REME`THIS (tea _DAY OF V \v/ • .20
ByelkviilftvN WHO IS PERSONALLY KNOWN TO ME(a OR WHO HAS
TYPE OR PRINT NOTARY
COMMISSION NUMBER
„�r,,,, KAREN S. NIELSEN
=io �,; State of Florida -Notary Publrc
- •- Commission # GG 207464
,��c My Commission Expires
n,ni„a•
(SEAL)
IDENTIFICATION.