HomeMy WebLinkAboutFilled Land Affidavit I
ST. LUCIE COUNTY
r-- -- - BUILDING & ZONING
2300 VIRGINIA AVENUE
p - FORT PIERCE,FL.34982-5652
GIC ` 772-462-1553
FILLED LANDS .AFFIDAVIT
I, the undersigned, am the owner of the following described property:
tin X201 IR9 - acro -- c
(Tax 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.
C e- -N) t�
Property Owner Name Property Owner Signature, Date 3 ` �
STATE OF FLORIDA,COUNTY OF, L e r
ACK'N'OWLEDGED BEFORE ME THIS DAY OF u �S 20 I
BYt lG.v�l C� /'���Ca C2 i.�S' _ WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION. ii
TQ� T 1 I .U31SOY-1
SIGNATURE OF ARY TYPE OR PRINT NAME OF NOTARY
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NOTARY PUBLIC TITLE ( �- 0 1 COMMISSION NUMBER
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"• 3,-` EXPIRES:December 14,2015
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