HomeMy WebLinkAboutFilled Land Affidavit PI1ANNING&DEVELOPMENT SERVICES DEPARTMENT
I ds Building &Code Regulations Division.
' 23()0 VIRGINIA AVENUE
FORT PIEiRCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
3 11-03So e20-f 97 000 f /- f z�lg w< f
(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 , 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.
1 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.
Proper Owner Name(PIease Print)
Prorkay Owner Signature Date
STATE Of COUNTY OF' -I-�-/�A-- --
(m
ACKNOWLEDGED BEFORE ME THIS t Q'�,/ DAY OF l &2 S�—.�20
BY /w► bac. �n _ii t-Z Y-" WHO IS PERSONALLY KNOWN-1.0 ME(K )OR WTIO HAS
likoDUt"!3D 1t s }r.t/e s b I(j �t:y�.S't� AS IDENTIFICATION.
`- - _........__._. _ .....
SIGNATURE OF N01'A . PUBLIC I'YI'F,OR PRINT ti`IMARY
01 ti-i u��� C4COMMISSI0N NUMBER
i
(SEAL)
SI.CPDSD Revised 04/1 T/2011 KEVIN.ANTHONY;HUMM,
Notary , b C-State of mai y"
N0.d1HU6329�rIIB':
Qiralitlad in`Bfaame'County
My G.ammissl#Ekpires Sdo.8.;2019