HomeMy WebLinkAboutFILLED LAND AFFIDAVITREC - '_:D JUN 2 6 2015
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, Fl, 34982-5652
(772) 462-1553 SCANNED
BY
FILLED LAND AFFIDAVIT St. Lucie County
1, the undersigned, am the owner of the following described property,
(Parcel W/Legaldescription/Address) 3,jo 1 5-%-. S,.VCA 'F-k. , r-j- 3cqcyq
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.
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Property Owner Name (Please Print)
Property Owner Signature Date
lAkM Aw
STATE OF FLORIDA, COUNTY OF ,
ACKNOWLEDGED BEFORE ME THIS 2 DAY OF 20
BY —WHO IS PERSONALLY KNOWN TOME LIZ OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
16017 COMMISSION NUMBER
(SEAL)
HEIDI A ' PUTNAM
NOTARY PUBLIC
STATE OF FLORIDA
SLCPDSD Revmd 04/11/2011 COMM#EE118017
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