HomeMy WebLinkAboutFire Department Permit PLANNING&DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
MMM-M
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersignneeld, am
amm the owner of ofrthe following described property,
34M
GC�0 C�
(Parcel Id#/Legald c iption/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.
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Property Owner am e Please Print)
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4iolierty Owner Signafure Date
�+LUCSTATE OF FLORIDA,COUNTY OF Q
ACMEDGED BEFORE ME T IS_!�DAY OF f)MyCh 20
BY WHO IS PERSONALLY KNOWN TO ME(—ZOR WHO HAS
PRODUCED AS IDENTIFICATION.
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SIG A OF NOTARY IUBLIC O PRINT NOTARY
COMM[ssibN44RA4ER _
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NOTARY PUBLIC
Y ' STATE;OF FLORIDA
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SLCPDSD Revised 04/11/2011 .�G'e"1 c� FVtres 6/23/2017