HomeMy WebLinkAboutFilled Land Affidavit I
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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 l
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described propert
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(Pareel IM/Legal'deseription/Address)
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for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number - d - , 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'Ibe 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 ame(Plea Pr. t)
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Property er Signature Date
STATE OF FLORIDA,COUNTY OF �.
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ACKNOWLEDGED BEFORE ME THIS�_DAY OF �� i II 20 _U__
By { I y j�o . 1���.] WHO IS PERSONALLY KNOWN TO MEOR)OR WHO HAS
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PRODUCED I AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NO I hm i
ffistonCOMMISSION NUMBER
KAREN S. NIELS(%NkL
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Commission # FF 11563
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My Commission Expires �
June 12, 2018
SLCPDSD Revised 04/11KAREN S.
♦♦♦,,PY PUU/C�' 1 1 5637
o Commission FF Expires
=A *_ my Commission Exp
" June 12, 201 8
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