HomeMy WebLinkAboutFilled Land Affidavit PLANNING &DEVELOPMENT SERVICES-DEPARTMENT
Building& Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL
82-5652
72)462-1553 I/rD
BAR 31
FILLED LAND AFFIDAVIT 2016
I,the undersigned, am the owner of ""'I'
the followingdescribedproperty,
S-20$ st4 h s /)
-e- �!v`d—
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number \G03-05$A , 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.
,no if 0 5 Ko .e
Property Owner Name(Please Print
(_yWopeoyt Owner Signature U Date
STATE OF FLORIDA,COUNTY OFS'i . Uc
ACKNOWLEDGED BEFORE ME THIS DAY OF Tl�0%{ 120
BY 56 S e�`R P SCCS\ WHO IS PERSONALLY KNOWN TO ME C_)-OR WHO HAS
PRODUCED T l �— AS IDENTIFICATION.
t�,nrA�iVe Yn3
SIGNATURE OF NOT PUBLIC TYPE OR PRINT NOTARY
EE:tS'r-1Q COMMISSION NUMBERpEFNNA g1VENS
to of Florida
N(� , public gta c 16,2p16
V PU N ices
EXP �E 61
comm.
o mission# 8 ol6ary Assn.
'i��q Op.� nded jhrou9
SLCPDSD Revised 04/11/2011 OF
90
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PLANNING &DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT RE�E�V APR 210
i
I,the undersigned, am the owner of the following described property,
-St� 6a - GC5<� ^ atVt5- a()a — S
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Developent Permit. In
accepting this Final Development Permit, BP Number \1ra6's-b 50z, 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)
Pr O er Signature Date
STATE OF FLORIDA,COUNTY OF S •�V C
ACKNOWLEDGED BEFORE ME THIS ` DAY OF O� Q C��\ 120 \0
BY �] S c d 111 k \S 1 WHO IS PERSONALLY KNOWN TO ME L OR WHO HAS
PRODUCED L 1` AS IDENTIFICATION.
SIGNATURE AARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBERpEANNA GIVENS Florida
State 2p16
c �:a Pie° otary Public 'c 16,
Comm•Explr s�E
858761
- = Commission otary Assn.
National N �•
SLCPDSD Revised 04/11/2011