HomeMy WebLinkAboutFILLED LAND AFFIDAVITPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
U049 C
I, the undersigned, am the owner of the following described property, oUn/(
4201-113-0001-020-9 & 4201-113-0001-010-6 / 9675 Range Line Road, Port St. Lucie, FL 34987
(Please see attached legal descriptions)
(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 , 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.
61I I H }�7 1a1Otit FL
Property Owner Name (Please Print)
ter-- /
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF CX:7r0%ejz_ ,�/ ,20
'I I�{ ,
BY j4p,% 70kt20 ^ems WHO IS PERSONALLY KNOWN TO MEd]! OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOT RY PUBLIC TYPE OR PRINT NOTARY
►'T�bAMISSION NUMBER (�`jrtQy �A. RYM
(SEAL) IVOT�YFti
STATE OF F�10RIDA
ConrldiFF1)73548
Expllres 3127R020
SLCPDSD Revised 04/11/2011