HomeMy WebLinkAboutFilled Land Affidavit PLANNING&DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIAAVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,'
09:,
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(Parcel Id#/Legal description/�'SPdress)
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.
6A'L_ 1 oar
Property Own Na a(Pleas Print
® X 1
Property Owner Signat<�j Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE iME THIS +, �DAY OF ZC _01 6-h—
BY M tc -o.L �/l Y1%.qr Cit WHO IS PERSONALLY KNOWN TOME L—)ORWHO HAS
PRODUCED \r AQ L V 5103— S J 50- - k41"O AS IDENTIFICATION.
l C i to kx-, T
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER-
(SEAL)
°spar vue�� EILEEN T.LONG
SLCPDSD Revised 04/11/21 * MY COMMISSION#FF 122372
EXPIRES:May 13,2018
_�rpoFFlo�`Oe Bonded Thru Budgel Notary Services