HomeMy WebLinkAboutFILLED LAND AFFIDAVITRECEI' D JAN 06 2016
• - SCANNED
BY
PLANNING & DEVELOPMENT SERVICES DEP }6� G+01111t1
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
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.
Property Owner Name (Please Print)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF ` Yf V L -R-
ACKNOWLEDGED BEFORE NIE THIS
!`� DAY OF Y—V)4Z.C- .204—�,
BY Y`(�lnS•�/i'�
"))WHO IS PERSONALLY KNOWN TOME OR WHO HAS
PRODUCED 1'(�,�
AS IDENTIFICATION.
L,�,'n(/� '� ) clerk-e� �
NOTS?
SIGNAT OF NOT
L
TYPE OR PRINTRINT
4 Q 191�a) CO
SION NUMBER
LINDA BAZELAISotary
Public •State of Florida
Comm. Expires Apr 13, 2017Commission.#
RM
FF 006231nded
National Notary Assn.SLCPDSDRevised08/24/2010
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