HomeMy WebLinkAboutFilled Land Affidavit PLANNING&DEVELOPMENT SERVICES DEPARTMENT
i` e Building&Code Regulations Division
2300 VIRGINIAAVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
R E C E I V 7 D JUN 43 011.016 FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
(Parcel Id#/Legal desc ption/ ddress)
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.
PQY-;:n � low
Propertyr Name(Please Print)
3�
ft
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF
ACWLEDGED BEFORE ME THISO DAY OF
BY Y�FSRS�ALLWN TO ME L_)OR WHO HAS
PRODUCED Z AS IDENTIFICATION.
C-
SIGNAT O ARY PUBLICA"YOR PRINT NO ARY
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011
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