HomeMy WebLinkAboutFILLED LAND AFFIDAVITe
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT S't. S
CU% oUh�
I, the undersigned, am the owner of the following described property,
description/Address)
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 (P ase Print)
Property Owner Signatefe
STATE OF FLORIDA, COUNTY OF=r-,O✓1 IC Ivej-
Date
ACKNOWLEDGEDBEFOREEM\ETHIS 090 DAY OF ,N11t1q� ,20j-�,
BY,'*-
V01 1 `�C . ri WHO IS PERSONALLY KNOWN TO ME do) OR WHO HAS
eRODUCED UY.�( � �ICe/tSP AS IDENTIFICATION.
c1
STGIVATURE OF OTARY PUBL TYPE OR PRI1W NOTARY
Ca I ( Y9 7 SCOMMISSION NUMBER
,p(;a SHERYL DEANNE GRIFFIN
StattS5U)orida-Notery Public
Commission W GG 119945
My Commission Expires
'nnuno June 28, 2021
SLCPDSD Revised 04/11/2011