HomeMy WebLinkAboutFilled Land Affidavit n.., .m PLANNING &DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division ( �,
Baum= 2300 VIRGINIA AVENUE ff c iJ
FORT PIERCE,FL 34982-5652 iaz
(772)462-1553 OCT 1 t�
A 2016
FILLED LAND AFFIDAVIT PERMHTTING
St. Lucie County, FL
I, the undersigned, am the owner of the following described property,
L,24, io,f t P ,Qc e-
(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.
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)
Prope(tZ O%XnerISign�ature D�t�
STATE OF FLORIDA,COUNTY OFj 1 U I ,
ACKNOWLEDGED BEFORE`ME THIS DAY OF 20 ,
BY �1����c �}O 1�l c \�N WHO IS PERSONALLY KNOWN TO ME C OR WHO HAS
PRODUCED �L. AS IDENTIFICATION.
1 In PSIS
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
S COMMISSION NUMBER
KARL NIELSEN
Commi Sion N FF 115637
My Commission Expires
�v��;;;;,�' June 12, 2018
SLCPDSD Revised 04/11/2011