HomeMy WebLinkAboutFilled Land Affidavit IN G &DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIA AVENUE RECEIVED
FORT PIERCE,K 34982-5652
(772)462-1553 JAN 13 2016
PERMITTING
FILLED LAND AFFIDAVIT St. Lucie County, FL
1,the undersigned, am the owner of the following described propertyj
—
3 4 001-(0 OF- 006'0-00c1)3 yr /o
(Parcel ld#ALegal 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.
R'09 �7' Kes
Property Owner Name(Please Print)
Property Own i g.n a-f u-re Ddte
STATE OF FLORIDA,COUNTY OF_ IT-ij
ACKNOWLEDGED BEFORE ME THIS DAY OF a n f-
T
WHO IS PERSONALLY KNOWN TO ME(i,6 OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
FE QL754bf) COMMISSION NUMBER
(SE
SUSAN ADIETER
Notary Public-State of Florida
SLCPDSD Revised 04/11/2011 MY Comm.Expires May 29.2018
........ Commission#FF 095280