HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT SCANNED
Building & Code Regulations Division Sy
2300 VIRGINIA AVENUE St Lucie
FORT PIERCE, FL 34982-5652 CDUr11y
(772) 462-1553 .
FILLED LAND AFFIDAVIT
=RECEIVE-FD
I, the undersigned, am the owner of the following described property,
4-7M 'IPDurkonax-� i
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.
Owner Name (Please Print) //� q
.{ YVI . 1011 `ell !
Owner SiP_nature Date
STATE OF FLORIDA, COUNTY OF U 1 1 V I C 1 l.1
ACKNOWLEDGED BEFORE ME THIS DAYOF l C7VC Ir .20 q
BY
PERSONALLY KNOWN TO ME (El OR WHO HAS
PRODUCED A-1r AS IDENTIFICATION.
&bri na -Hyt i ngfDn
SIGNATURE OF VOlYARY PUBLIC TYPE OR PRINT NOTARY
O 21 COMMISSION NUMBER
(SEAL)
SLCPDSD l wimd 04/112011
lef Sabrina M AnirlgtonPi
+� g My Commies GG 908779
v�awdr Expires 09272023
3