HomeMy WebLinkAboutFilled Land Affidavit - ,- , PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
• 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
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(Parcel Id#/Legal description/ rens V��
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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/*opkrtyOwner Name( ea Print)
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Property Owner Signature Date
STATE OF FLORIDA,COUNTY O
ACKNOWLEDGED BEFORE ME THIS DAY OF 20JZ— ,
BY ILIl WHO IS PERSONALLY KNOWN TO ME L_)OR WHO HAS
PRODUCED 17 AS IDENTIFICATION.
SIGNATURE OF AR LIC TYP PRINT NOTARY
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011 ;iR`• Y'v�4, AUDREY B.HUMP HREY
.: MY COMMISSION It FF 174772
A•. ,:a EXPIRES:March G,2019
'• Bonded Thru Notary Public Underwriters
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