HomeMy WebLinkAboutFilled Land Affidavit PLANNING& DEVELOPMENT SERVICES DEPARTMENT
Building-&Code-Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE;FL 3499Z-5652.
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned,am the owner of the following described property,
5�i N Na roto a Q ve f St Lu ci e FL 34483.
(Parcel Id#/Legal description/Addre s)
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 CountyLand Development Code-J 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 obligpd. nor liable to-provide for,-or maintain -in-any form,
-adequate drainage off my property which will not adversely affect the, immediate
community.
reli L7r L
Property 0weer Name(Please Print)
5 11 ) 15
Property Owner Signature V Date
STATE OF FE01MYA,,COUNTY OF Wa J�Ao e
- - ACKNOWLEDGED BEFORE ME THIS DAY OF 20
BY I (Pi� IJ• C� '�n U[� HO IS P ONALLY-KNOWN TOME.( 1 OR WHO HAS
PR D CED N\n ,�/'/�Vt JYI�S I CCn
i � {_ AS TDENTTFiCATfON.
' NOTARY PUBLIC TYPE OR P T NOTARY
O COAWSSION NUMBER
(SEAL).
L ry TANYA SHEETS
SLCPDSD Revised 04/11/2011 °y NOTARY PUBLIC
STATE OF NEVADA
,•H��a�P9 My Commission Expires:August 10,2016
Certificate No:05.100661-2