HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
;..:..2300 VIRGIA7A AVENUE ..
FORT PIERCE, FL 34982-5652 �o
�L�
- - (772) 462-1353 -
MAR 3 0 2017.
6GANNED FILLED LAND AFFIDAVIT,. ERfdIITTIRC,
. - .. Lucie Cou.
BY st. �� nt„ PL
St: LucieCounty
I, the undersigned, am the owner of the following described property,
(Parcel I(f#/Legal description/Address)
for which I have applied to St...Lucie County for:a Final Development Permit In
accepting -this Final DevelopmentPermit;'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 DevelopmentCode, 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 ase Print) -
Pro wner-Signature Date
STATE OF FLORIDA, COUNTY OF Od/ • L-Lf(/CJrI� �./ ..
ACKNOWLEDGED BEFORE
-ME
TTHHI�S+ 26 DAYOF/-L�(CKI�`��� ,201 /
BY\YJ/'!/ 10.� l%/(.e._]S - WHO. IS PERSONALLY KNOWN TO MEC16OR WHO HAS "
.. `. _ PRODUCED n AS IDENTIFICATION. ..
.. ..... . - ..: SIGNATURE OF NOTARY PUBLIC - TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL): ... .:
Kali DEBORAH BOERCKEL'
MY COMMISSION ik *,001318 -
-: SLCPDSD Revised 04/1112011 U MPRn AprR 1Z 2017
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