HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
SCANNED
FILLED LAND AFFIDAVIT St. Lucie ie
County
I, the undersigned, am the owner of the following described property,
149-(3-191-0005-00o-D �401 cis Ncx9y t
(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 ti. -- '�I cknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(1)), 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.
fI-�ca���l� �
Property Owne Flame (Please Print)
Property Owner Signature Da
STATE OF FLORIDA, COUNTY OF 1— yj&n
AC OWLE ED BEFORE ME THIS DAY OF YI. 20�,
BY •e WHGI&PERSGNALLY KNOWNTOME.(Eb OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
-71.J.7 J COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04111/2011.
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