HomeMy WebLinkAboutFilled Land Affidavit ti � ;— PLANNING &DEVELOPMENT SERVICES DEPARTMENT
21 IMIZ �' Building &Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652 i
(772)462-1553
FILLED LAND AFFIDAVIT JUN O 1 �Qp
PL-ilr41TTING
St. Lucie County, FL
I,the undersigned, am the owner of the following described property,
A� "
(Parcel Id#/Legal description/ dress)
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.
0 64Property Owner Name(Please Iint)
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF �-- \. h-U V t C .
ACKNOWLEDGED BEFORE ME THIS DAY OF E !.I —20-110
YQ1 i� �r�nn
B �1 WHO IS PERSONALLY KNOWN TO ME U OR WHO HAS
PRODUCED AS IDENTIFICATION.
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SIGNATURE-OF TARY PUBLIC TYPE OR PRINT NOTARY
r I COMMISSION NUMBER
KAREN S. N1� 7
Commission# FF 115
'= My Commission Expirzs
June 12, 2018
SLCPDSD Revised 04/11/2011