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#1773- Deed; CONSENT TO ANNEXASTION 1709 State Road 23
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#1773- Deed; CONSENT TO ANNEXASTION 1709 State Road 23
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2/4/2025 11:01:29 AM
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Water Line Survey Form <br />Yes, I desire hookup to the water supply offered <br />by the U.S. EPA, and will be able to attend the <br />meeting times on S<w-p- ;%, 3 <br />Yes, I desire hookup to the water supply offered <br />by the U.S. EPA, but will not be able to attend <br />the meeting times on <br />No, I do not desire my residence to be included in <br />the water supply offered by the U.S. EPA. I <br />understand that by refusing this offer, if the <br />plume of contamination should spread to my home, <br />I, as the homeowner will be responsible for any <br />remediation costs. Also, I understand that any <br />filter currently provided by �►t-!/11�'�- :SfN�'.�; <br />will be my responsibility <br />to maintain. rrx <br />Name: <br />Address: 0' (C ` cliff <br />------------------------------------------------------------ <br />J'y <br />O <br />
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