HomeMy WebLinkAboutEasementsEASEMENT DEDICATION SHEET
To be filled in and submitted with construction plans and specifications for preliminary review
(Not to be used where City is purchasing property)
THIS SECTIO TO BE COMPLETED BY CITY OW /
PROCESSED BY: DEPT. U 0 V EXT 3 /
T.� EX
C5 v
REQUESTED BY: DEPT. EX
ACCOUNT NO. - � () ' S 7/
J D PROJECT NO. Al
(For ordering tit a work, appraisals, etc.)
TYPE OF EASEMENT: /
J[ Tem ora Blanket PUE Electric Only
Public Utilities (PUE) p ry Water Only
(prior to building permit)
SPECIAL INSTRUCTIONS:
REVIEW AND APPROVAL REQUIRED /GIVEN BY THE FOLLOWING DEPARTMENTS:
Approval Required By: Electric Approval Given By: Electric
Water/WW (please initial) Water/WW
(please initial) Asst. City Engineer
Asst. City Engineer Public Works
Public Works
METES & BOUNDS DESCRIPTION CHECKED FOR CLOSURE BY: (City Staff - Name/ t.)
THIS SECTION TO BE COMPLETED BY APPLICANT
PROPERTY OWNER(S):
4Q- o
must be exactly as they appear on
PHONE NUMBER: ( }� ��U ZZs -�
ADDRESS: 1 O � G� � O O
ALL LENDERS (Please furnish copies of all lien documents): (Names and Addresses)
IF OWNER IS A CORPORATION, PARTNERSHIP, OR JOINT VENTURE (also see #5 below):
1. State of Incorporation /Registration (e.KQS
2. Partners' Names (if applicable)
0- C 3. Person Authorized to Sign (� aY l �d e � r `S'�►�
(Na me a a Title)
LEGAL DEPARTMENT MUST BE PROVIDED WITH THE FOLLOWING:
(Please check items that are attached)
.i 1. A copy of a recent (within 90 days) deed or title insurance policy showing the names of the grantors /owners; and
2. For unplatted property, a signed, sealed and dated metes and bounds description and a diagram of the property
— showing the location of the easement; or
Pkb For platted property, a copy of the plat showing the lot, block, subdivision, and recording information.
�/d. For blanket easements, a signed, sealed and dated metes and bounds description and a diagram of the property.
Corporate or partnership owners must furnish a copy of a corporate resolution or other proof of authority to sign on behalf
of the corporation, partnership, or joint venture.
�. Name, address and phone number of person who is to receive the ase; and be responsible for getting It executed:
CfY �Y L / X C o o Owl
Any land acquisition resulting from Capital Improvement Projects requires a meeting with the Legal Department.
bslo: Ideve serTorms12001 internet applications leasemen t dedication sheet.doc