HomeMy WebLinkAboutFILLED LAND AFFIDAVITr,
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
o Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT �Cq!�N
ft
ey
�r;A County
I, the undersigned, am the owner of the following described property,
2212-500-0003-000-3, 15838 Orange Avenue, Fort Pierce, FL
(Parcel Id#/Legal 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, 1 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 Owne lame lease nt)
Proe—rty Owner Signature D e
STATE OF+L9RCOUNTY OF
ACKNOWLEDGEDEBEFOR^M►EcTHIS
'f+' DAY OF ff :) ,20 /,
n�fTF� BY &>>�A 6(Z- WHO IS PERSONALLY KNOWN TOME ()V-) OR WHO HAS
PRODUCED
SIGNATURE OF NOTARY PUBLIC
MARLENAcLAWRENE UMBER
NOTARY PUBLIC OF NEW JERSEY
MyCommise4onExp,Tes813012015�-"
SLCPDSD Revised 04/11/2011
�1Ii� .tu L i
TYPE it
(SEAL)
AS IDENTIFICATION.