HomeMy WebLinkAboutFILLED LAND AFFIDAVITSCANNEQ
*mil. BY
St. Lucie County
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,
• (Parcel Id#/Legal dg3cription/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 tl'iat 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.
Ke t S ►-1 J ObM �✓t_
Property Owner Name (Please Print)
Property Owner Signature I)at
STATE OF FLORIDA, COUNTY OF ? 1
ACKNOWLEDGEEREFpME FB TS�4� DAY OF QCT��GK— ,20 1�
D B
BY ��'I�r' $i�etr WHO IS PERSONALLY KNOWN TO ME V"'ORWHOHAS•
PPQDUCED AS IDENTIFICATION..
641
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SIGNATURE Of NOTARY PUBLIC TYPE OR PRINT NOTARY
�G �• CtSMMISSION NUMBER
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NOTARYPUdLIC
�ZA STATE OFFLORIDA
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SLCPDSD Revised 0824R010 • 'I4.C6"1131 Explres 3/27/2016