HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUF
FORT PIFRCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
S.
I, the undersigned,
am the owner of the following described property,
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'A: Aim, -41
(Parcel ld#/Legal desq�ption/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number I 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 WELL 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
STATE OF FLORIDA, COUNTY OF a t'6t=L0-; -e-
ACKNOWLEDGED BEFORE ME THIS JrJ DAY OF 2A [I a 20
1-j
BY HO IS PERSONALLY KNOWN TO ME 0) OR WHO HAS
PRODUCED
P12,09j/ '� '1'r-'Onm
TYPE OR PPNT NOTARY
(SEAL)
CASEYFRENCH
f:', Notary Public — State of Ficnitla
SLCPDSD Revised 04/11/2011 'd *4 Connnnission#GG167258
,,�'!VMy Comm. Expires Dee 11, 2021
Bonded thnsugh Rabonal NoLaryAssn,
AS IDENTIFICATION.