HomeMy WebLinkAboutFILLED LAND AFFIDAVIT�4O%��2�0
PLANNING & DEVELOPMENT SERVICES DEPARTMENT CO
BUILDING & CODE REGULATIONS DIVISION 4�/1i
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,
Z. 411_--o o as
(Parcel
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.
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Property Owner Name (Please Print)
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Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF 1 41-tM �ts Ua'tt
ACKNOWLEDGED BEFORE ME THIS � � DAYOF I' A A,201 Z
BY Dm31- 'll^t (5 L k- t S WHO IS PERSONALLY KNOWN TOME OR WHO HAS
COMMISSION NUMBER
SLCPDSD Revised 08/242010
AS IDENTIFICATION,
TYPE OR PRINT NOTARY
;��o MY COMMISSION # DD901750
�'?;oFn;�'.�` EXPIRES June 23, 2013
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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 WRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
1, the undersigned, am the owner of the following described property,
Ig- Z
Id#tLegal d
ol- a�<3-O
for which 1 have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number 1 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.
—Ii
?3
Date
STATE OF FLORIDA, COUNTY OF ST. L _,
ACKNe�OWLEDGED BEFORE ME THIS
� QAR mYOF T -201'�
BYerj 1're � V WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUCED
GNATUR P LI
IWI COMMISSION NUMBER
SLCPDSD Rmiud 08242010
AS IDENTIFICATION.
TYPE OPRINT NOTARY
N QOft l���u��
(SEAL)
1YtARLENE U. HOWARD
MY COMMISSION N DD810081
R7�IRES: ORoba 23.2012
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