HomeMy WebLinkAboutFILLED LAND AFFIDAVIT_ S
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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
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SCANNED
BY
St. Lucie County
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 accords ce 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 forth,
adequate drainage off my property which will not adversely affect the immediate
community.
Property Own Name (Please Prin
Property Owner ignature Date
STATE OF FLORIDA, COUNTY OF , - 4 U C. r -e-
ACKNNOWLEDGEED BEFO METHI Is7h DAYOF T XI 'V4 J401 ,20
gy(�(J.i/ii0✓Ii /IA �iN/1 WHO IS PERSONALLY KNOWN TO ME WHO HAS
PRODUCED
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
PF J.2 o Y/.:COMMISSION NUMBER
SLCPDSD Revised 0824/2010
AS IDENTIFICATION.
(SEAL)
tiM:B�•.,, ILONA A NANOINO
Notary Public - 0Ms o1 Floft,
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