HomeMy WebLinkAboutFilled Land Affidavit „e PLANNING &DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described,property,
SaYe-NM- eM &4- 4/1-; //,/'{� (W5,2 ��1/�eri) �irc�e
(Parcel Id#/Legal description/Address))PQ ra/ ZD 3 yas-1013 -0;3,2-000
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 lin 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.
a 14,01�1 ej div
Property Owner Name(Please P int)
Property Owner ignature Date
STATE OF FLORIDA,COUNTY OF Sf• L u C)' r—
ACKNOWLEDGED BEFORE ME THIS 2-D _DAY OF-FA
By d_tVH0 IS PERSONALLY KNOWN TO ME( )Y OR WHO HAS
PRODUCED AS IDENTIFICATION.
______SIG. URE OENOTARY-PUBLIC.______-___ . _ TYPE OR P RNT NOTARY-
-7
OTARY,_/ V%(,COMMISSION NUMBER
(SEAL)
CYNTHIA CARRAN KELLY
• •.`� Nolary Public State of Florida
SLCPDSD Revised 04/11/2011 s; '.�My Comm.Expires Apr 10.2018
F�aL: Commission N FF 077980
1111111\\\\
I