HomeMy WebLinkAboutFilled Land Affidavit PLANNING&'DEVELOPMENT SERVICES DEPARTMENT -
Building&Code Regulations Division
• 2300 VULGHS11A AVENUE
FORT PIERCE,Fl,34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
1,the undersigned, am the owner ofthe following described property,
S 0 1 q - 5}O -`>-,-lR!Z -0Uc
(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.
Property Owner Name(Please Print)
Property,Owner Signature Date
STATE OF FLORIDA,COUNTY OF LQ0.I
I
ACKNOWLEDGED BEF7 ME THISQ!:j DAY OF \bMIMAYfz 20
A, 1110' WHO is PERSONALLY KNOW&ME L—)OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE AR P L TYPE OR PRINT NOTARY
Fri 1!901� COMMISSION NUMBER
KAREN S. NIELSEN EAL)
Commission# FF 115637
MY commission Expires
June 12, 2018
SLCPDSD,Revised 04/11/2011