|
`—,�. -
<br /> �wu.o,m�.,�� o��„b�� ��
<br /> Rsr.4Y0 Pup�a SourA MMpN lb�Fp I��oCWbn�
<br /> P�o•+a�=wa• INFORMATION fORM �«p�+7s nESERVEo
<br /> FOR PFiOPE�3TY-f HAT IS . �
<br /> UOTH UNPLATTED AND UNIMPROVED �
<br /> /lOOE CWfPLEiEO UY SELLEH 4YMEN PROYERlY IS IISTEDI
<br /> Pleaee unawor eech ol ths lollowln0 qusellone. It you do nol know the anawer or have che�kad¢nythinp In Ihe�sllhand calumn,�le�sa a:pldn rh�
<br /> In Iha�paca provlded al the end ol Ihle lorm. i
<br /> �L !� .
<br /> PropenyAddreasorLxellon: 7��X L:a�J ��CN 1>YIVC�
<br /> LegelOeecdptlon: L.7f �7 ''7,r G11r�T��:°�n �/�!7 _ �
<br /> / - �
<br /> !3�� fla�IProperlyTaxlDNo: L�L (�iR- C�C�n- (� ��-O�7
<br /> �C�
<br /> A y�� Uwner'e Namej�).(pieaca pdnl): C:�)Q V I .S 7. ��N Lt*4 D/'1 ___
<br /> 9��� 1, How lonp li�va you ownad Iho properry? � yeen
<br /> t+ �T �
<br /> H z H 2. ENCROACNMENTSIEASGMENTS.(o.g.lonoos,buildings,iackories,tlmcways,parden,ete.)
<br /> � n ❑Yos �Na A. Doo�anything on your proparry oxlond onlo(oncroach an)your neightor's propory7
<br /> y�7 ❑Yos [,ZNo B. Doas anyNln9 on your noiphbor's proporry ozlond on'n(o�roach on)/our proparry7 �
<br /> O� H„O� 0 Yos p No C. A�o you awaro ol any oa�amonls or olhor's righLs aflecGnp Iho proparry9 (II'Yos',dosaibo in Ne remarl�s spaco bolow)
<br /> V]H
<br /> yx 0. ACCE55. II tho properry is not on a public sVaot: '
<br /> [�] O E. ❑No ,QQ Yos A. Is Ihuro a road or easuman�for accoss lo lho propory7 �
<br /> y b ❑No 8 Vos 8. II your answor to A is'Yos',Is II racordod4 �
<br /> p� �� [�No ❑Yos C. Illhoraidaraccossissharetlwilhanyatnurproporry,isMaioawtiltonaproomonitorshannglnomaiNonanceandrapairemb9i
<br /> {J No ❑Yos D. �I your answar to C is'Vos',Is a copy anachod Io Nis lorm7
<br /> ��n ❑Yos �No E. IllhoroatlorothoraccossisimprovoC,�slhoroanyslanOmgorrunningwatar,Iloodingormudtha�aHoclsusoolNoacoossdurinp '
<br /> x H Q m�ame ol Iho year? �
<br /> 3
<br /> z
<br /> �i y z 4. SURVEY.
<br /> yH Yes ❑No A. Has tha pmporry evor baon surveyod7 ,
<br /> g H �Tlo �Yes 8. II your answor to A le 'Yes•,is a copy ol No survoy attacliod7
<br /> C] C V�
<br /> � �� 5. PROPERTY BOUNDAqIES.DounEe iha propotry bouMarbs:�o.�.fence,hedge,survoy slakes,rockory,otc.)
<br /> HO(y/� Nohh hno: f,or���. �
<br /> Soulhlino: f"'A�I�Pi �
<br /> e..ii��: E'�:;� �'I��.� pa.;�,,�.
<br /> ,
<br /> . W��Une: �-2 n f-. G� �' �.
<br /> I
<br /> 6, 20NIN0 8 RESTRIC110N5. �
<br /> A. Tho prownl xonirg ol Ifw proporry Is .�i {_-�7,�1(1c`� l�j.
<br /> �� ❑Vos �Na B. Aro you aware ot any unusual wunry,dry or prrvato rustrictlons on use ol Cro poporry,IndWing fuWro construcUa�9
<br /> �� ❑Yos GI No C. Is�ho proporry a anyµvt ol it in a povornmont dosipnalod shorollrw masler plan,siido area,�Oarid or othor onvironmon�lly '
<br /> �f sonsilrva aroa7 ,
<br /> r
<br /> � 7. SOIL STABILITY AND CAMAMINATION. ' �
<br /> � �" QVos f7�No A. Arayouawareolanysonlertwnt,oartAmovomont,aatlilog,slidosasimllarprodomsonthopoperryorinlholmmodWloarwT•; I�
<br /> e' ❑Yos &�No B. To No bost ol your NnoW�tlpo,h'ss any part ol No propory bron buiit up with hll ditl,waslo a other mabiial7 ', ,
<br /> ❑Vo5 �No C. Has Nem ever Eoon a somrn sution,aulo ropair shop,dry Goarwrs,prinunp slwp,manutxNdnp ladliy,or any otfwr uss d� ; �
<br /> No pioporry whic�mg�t have contaminalod Iho soilT '
<br /> '�' �' �No ❑Yos D. Has No proporry baen tosud la hazardous wasto conlamination9 (il'Yos',attach a copy al tl�o I�pocGon roport.) I
<br /> w.�
<br /> 8. FLOODING OR SEEPAGE.
<br /> ❑Yos ,g�No A. Is there slandirp walor on Ihe proporry durinp any umo of Iho yoaf! •
<br /> .,� ❑No ❑Yus B. II your answar to A is'Yos'have you dono anylhing to coual Cie problom9 y
<br /> ��� ❑Yes ,.�]t!o C. Ia iho properry bwtod In a gwemment dosignaled fbal zono or Ibod plain7
<br /> 9. SEWAOE. �
<br /> p,,,� A. Is iho properry served by: �publlc sowor maln, ❑soptic tank sycmm, ❑oLhor disposal cyslem(desaiba):
<br /> �,_� � v
<br /> ..O No ❑Yn B. Whoro is tho noarest publie sowor maln toeatotl7���aoss the uw - `sido(s)ol ltw property; �
<br /> ❑Othor��oscriDo�: i�i�T 5i./-�2J
<br /> �,CYns ❑No C. If lnoiu is a saxor maln aaoss ano w mwe sltlos ol Iha pioporry,k Nore a cannection a hook�on charpe payable Wlwe ths ,„j
<br /> o.,� woPo�y c�,oe ow,r�oaaa w me sewon Y
<br /> D. II your answor to C is'Yos',how much is Uw charpo9 S
<br /> �No ❑Yos E. Hasanappliwlwnlwapprovalola'poliminarywilswporCor'drainlio�ddasign'Qormotly'soptiesystom')ovorbaonlilodMi�h
<br /> tho ciry or counry7 �
<br /> ❑No ❑Yos F. II your ansxror to E is'Vos',was 11 approvod7(II'Yos',anach Iho appraval.)
<br /> ❑Vns (�No G Is or will any'onhancoO'sowapa disposal systum ho ra�uimd9(o.p.,a prossuro disvlbuUon or mound systom.)
<br /> I� �
<br /> 10. PUBLIC WATER. �
<br /> ❑No J�Yos A. Is Ih�propery servod by a pudic wator maln7
<br /> B. Whoro is No noarosl walor main loeatod7�paoss tho -�y�,r� aldo�s)ol Uw propety; ❑Othar
<br /> (Dauribe): _�
<br /> C. II thoro is a wator maln acioss ono or moro sldos al No popar,y,Is�horo a mnnoctlon or hook•on charpe payaGo boloro tl�e
<br /> p�oporry can bo tonrronoO to Iho walor mvn7 � �
<br /> 0. II your answnr to C is'Yos',how much is Ifw chargo7 S�
<br /> `
<br /> ❑No ❑Yos E. HavoyouohlainalaCortitiwloolWatorAvailaOdiylromihoCiryorWa�orDrstrklservingNoproporry7Q1'Yos',attachaoopy.)
<br /> 11. WELL It tlw propairy Is sorved by a walor woll.
<br /> VA. �No �Yos A. Is II a pmalo woll scrvmg only Ihis propoiryT
<br /> r� ❑No �Yos B. Will i�prwido an atloquato year round supply ol wa�ur for iho propuiry?
<br /> ��T 1 � I
<br /> Sollais'Initails � i - ' ��� �
<br /> 1' K
<br />
|