| 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 or an aerobic wastewater system has been or
will be installed in accordance with the permitting provisions of the Trinity
River Authority. Said system being on
lots ______________ shall bind these lots as one unit not to be sold or
transferred individually. 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:_______________