| THE COUNTY OF
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____________________________ |
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| STATE OF TEXAS
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Before me, the undersigned
authority, on this day personally appeared_________________________
_____________________________________ who, after being by me duly sworn, upon
oath states that he/she is the owner of record of that certain tract or parcel
of land lying and being situated in _______________________, County, Texas, and
being more particularly described as
follows:________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
The undersigned further
states that a wastewater system has been or will be installed in accordance
with the permitting provisions of the Trinity River Authority. Further, the undersigned states that he/she
will, upon any sale or transfer of the above-described property, notify any
buyer or transferee of the condition.
For more information concerning the rules or regulations on wastewater
systems, please contact the Texas Commission on Environmental Quality
(TCEQ) , P.O. Box 13087, Austin, Texas 78711-3087.
WITNESS MY/OUR HAND(S) on
this ________day of __________________, ______________
____________________________________________
Name(s)
of Homeowner(s)
SWORN TO AND SUBSCRIBED
BEFORE ME on this _______day of
___________________,
________by
________________________________.
_____________________________________
Notary
Public, State of Texas
Notary’s
Printed Name:________________
My
Commission Expires:_______________