Owner(s) Declaration of Annexation with Provision for Municipal Services Upon Owner Extension of Water and/or Sewer Services (Annexation):
I (We) certify: (i) that I (we) have requested the Town to provide water and/or sewer to the property(ies) depicted on this map; (ii) that I (we) submit a voluntary annexation petition to the Town for the property(ies) depicted on this map; (iii) that I (we) acknowledge and agree that the Land is not currently serviceable by the Town’s water and/or sewer system, but development plans provide for extension of water and/or sewer by the Owner; (iv) that I (we) acknowledge that at the time of annexation and until such time the Land is serviceable by the Town’s water and/or sewer system, the Town will not provide water, sewer, or sanitation services to the Land; and (v) I (we) acknowledge and agree, that notwithstanding if the Land is annexed into the Town, the Town shall have no obligation to provide water, sewer, or sanitation services to the Land; provided that upon (i) the Owner, at its sole expense, completing the infrastructure required by the Town to extend water and/or sewer to the Land; (ii) the dedication and acceptance by the Town of such Required Infrastructure; and (iii) the application for and approval of utility allocations by the Town, the Town will provide water, sewer, and sanitation services to the Land. The terms and provisions of this certification are further memorialized in Declaration of Annexation with Provision for Municipal Services Upon Owner Extension of Water and/or Sewer Services recorded in Book ________, Page __________, in the Office of the Wake County Register of Deeds, said Agreement being incorporated herein by reference. Said agreement and this certification shall be binding upon the undersigned owner(s), their heirs, successors or assigns.
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_______________________________ State of North Carolina, County of
_______________________________ I certify that this (these) person(s) personally appeared before me this day of:
______________________, 20________, each acknowledging to me that he and/or she voluntarily signed the foregoing document for the purpose stated herein and in the capacity indicated:
_____________________________ SEAL
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_____________________________ Notary Public
My commission expires: ______________________, 20________
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