HomeMy WebLinkAboutFilled Land Affidavit r v �, PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652 �C"
(772)462-1553
�G
FILLED LAND AFFIDAVIT
0
0-
0
I,the undersigned, am the owner of the following described property,
\a 13NSI 6(34'o
(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 W ko•O'A41 , 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.
ro rty Owner Name(Please Print)
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF �� ��C
ACKNOWLEDGED)BEFORE ME THIS DAY OF 06&/ w 20
BY WA& Ulf/F� WHO IS PERSONALLY KNOWN TO R WHO HAS
PRODUCED AS IDENTIFICATION.
SI rATURE OF NTARY PUBLIC TY�(SR PRINT NOTARY
Ff D b r/COMMISSION NUMBER
0ENKE DAWNESE SMITH
MY COMMISSION#FF909628
. ,. EXPIRES August 16,2019
c07iJ9Batiiti.� PoorkfeNolaryServ�.cap
SLCPDSD Revised 04/11/2011