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HomeMy WebLinkAboutApplication APPLICANT 12/8/2021City of Springfield Development & Public Works 225 Fifth Street Springfield, OR 97477 Land Division Plat Partition, Subdivision SPNINGFIE, D ,Application Type (Applicant: check one) Partition Plat Pre -Submittal: ❑ Subdivision Plat Pre -Submittal: ❑ Partition Plat Submittal: Subdivision Plat Submittal: ❑ Required Project Informatina (Applicant: complete this section) Applicant Name: c) pi's (c ¢\ Phone: Company: ( TN' Luc, Fax: Address: -I%S `IT4ioz- A licant's Rep.: -Jp Phone: Company: p 1 C.I NIC Fax: Address: P.m.Qao ZSL-'1 EUC:7�.M1= e¢_ -T74--�2— Pro ert Owner: 4cok mvii L x� Phone: Company: Fax: Address: 995 ST. E ert. 97�Z ASSESSOR'S MAP NO: L circ- TAX LOT NOS : 1700 Property Address: 404 Mrh: .yT, gp pw-- , g74-1 Size of Pro ert Oj 4 Acres ❑ Square Feet Proposed Name of Subdivision: K Description of If you are filling in this form by hand, please attach your proposal description to this application. Proposal: 1 /K, OF FIN*L- PA¢-T1Tlou P — F� �Ecoi2-41nF Existin Use: !Z$51 DE.1.tR- A -L. Tentative Case #: U- (41l,C001h01 # of Lots/Parcels: 2. !Avg. Lot/Parcel Size: . sf Densit : 4( du/acre Signatures: Please sin and print your name and date in the aggrogriate box on the next oape. Required Project Information (City Intake Staff., complete this section) Associated Applications: - Pre -Sub Case No.: Date: Reviewed by: Case No.: Date: l,1k1 t.OL1 Reviewed by: Application Fee: $ 31S sUZi Technical Fee: $ M6-11;;- Postage Fee: $0 TOTAL FEES: $ t��(J •�S PROJECT NUMBER: Vlf-1 -OW301-?NT Revised 10.14.13 kl 1 of 6 P2 Owner Signatures This application form is used for both the required pre -submittal meeting and subsequent complete application submittal. Owner signatures are required at both stages in the application process. An application without the Owner's original signature will not be accepted. Owner: The undersigned acknowledges that the information in this application is correct and accurate for scheduling of the Pre- Submittal Meeting. If the applicant is not the owner, the owner hereby grants permission for the applicant to act in his/her behalf. I/we do hereby acknowledge that I/we are legally responsible for all statutory timelines, information, requests and requirements conveyed to my representative. Date: Signature I represent this application to be complete for submittal to the City. Consistent with the completeness check performed on this application at the Pre -Submittal Meeting, I affirm the information identified by the City as necessary for processing the application is provided herein or the information will not be provided if not otherwise contained within the submittal, and the City may begin processing the application with the information as submitted. This statement serves as written notice pursuant to the requirements of ORS 227.178 pertaining to a Date: Revised 10.14.13 kl 2 of 6 Land Division Plat Application Process (see next page for a diagram of this process) 1. Applicant Submits a Land Division Plat Application for Pre -Submittal • The application must conform to the Land Division Plat Pre -Submittal Requirements Checklist on pages 4-6 of this application packet. • A pre -submittal meeting to discuss completeness is mandatory, and pre -submittal meetings are conducted every Tuesday and Friday, from 10:00 am - noon. • Planning Division staff strives to conduct pre -submittal meetings within five to seven working days of receiving an application. 2. Applicant and the City Conduct the Pre -Submittal Meeting • The applicant, owner, and design team are strongly encouraged to attend the pre - submittal meeting. • The meeting is held with representatives from Public Works Engineering and Transportation, Community Services (Building), Fire Marshall's office, and the Planning Division and is scheduled for 30 to 60 minutes. • The Planner provides the applicant with a Pre -Submittal Checklist specifying the items required to make the application complete if it is not already complete, and the applicant has 180 days submit a complete application to the City. 3. Applicant Submits a Complete Land Division Plat Application • When the applicant has addressed all items on the Pre -Submittal Checklist and the City Surveying Section has notified the applicant's surveyor that the plat and other documents are sufficiently refined, the applicant can submit a complete application to the City Survey Section located in the NW Quad of City Hall. • The application must conform to the Land Division Plat Submittal Requirements Checklist on page 6 of this application packet. • If the submittal is deemed complete, the City Survey Section will sign -off on the City Survey approval sheet and send the applicant to the Development & Public Works Department for application submittal and fee collection. • Planning staff checks and signs the mylars. 4. Applicant Records Plat at Lane County & Submits Plat and Documents to City • After Planning staff checks and signs the mylars, the plat may then be recorded by the applicant's surveyor at Lane County. • After plat has been recorded at Lane County, applicant submits five (5) recorded, rolled paper copies of the plat and three (3) copies of required documents to the Development & Public Works Department prior to the issuance of building permits. Revised 10.14.13 kl 3 of 6 LAND DIVISION PLAT APPLICATION PROCESS Applicant submits land division plat application for pre -submittal (See Land Division Plat Pre -Submittal Requirements Checklist) City departments review application for completeness and hold pre -submittal meeting to discuss completeness issues with applicant and applicant's representatives. Applicant addresses incomplete items. City Surveyor checks application and returns comments to applicant's surveyor. Applicant's surveyor corrects plat City Surveyor conducts field check and and returns to City Surveyor. returns comments to applicant's surveyor Applicant's surveyor sets new monuments and flags existing ones. Once no errors appear on the plat and a current title report is submitted, applicant's surveyor is given ok to submit complete land division plat application. After ok given from City Surveyor and applicant has addressed all incomplete items from pre -submittal, applicant submits complete application to the City Survey Section (See Land Division Plat Submittal Requirements Checklist) City Survey Section signs -off on City Survey approval sheet and sends the applicant to the Development & Public Works Department for application submittal and fee collection. Planning staff checks and signs mylars and notifies applicant's surveyor of approval. Applicant takes plat and accompanying documents to Lane County for recording. Applicant brings copies of recorded plat and documents to Development & Public Works Revised 10.14.13 kl 4 of 6 Land Division Plat Pre -Submittal Requirements Checklist NOTE: If you feel an item does not apply, please state the reason why and attach the explanation to this form. ❑ Application Fee - refer to the Development Code Fee Schedule for the appropriate fee calculation formula. A copy of the fee schedule is available at the Development & Public Works Department. Any applicable application, technology, and postage fees, are collected at the pre -submittal and submittal stages. ❑ Land Division Plat Application Form ❑ Letter Addressing Conditions of Approval - lists and addresses each condition of approval, detailing the actions taken and current status of each item. ❑ Five (5) Paper Copies of the Plat stamped and signed by the surveyor. ❑ Two (2) Copies of Closure Sheets for the boundary and each lot or parcel and all common areas, dedicated areas, and easement areas that are not simple parallel offsets. ❑ Two (2) Copies of Title Report or Subdivision Guarantee for the parcel being divided. The title report must be dated within 30 days of submittal at the time of the final submittal. An older report is OK at the pre -submittal stage. ❑ Two (2) Copies of Each of the Reference Documents and Plats listed on the plat. ❑ Two (2) Copies of Each of the Supporting Documents - the vesting deed (must vest title to the owner listed on the plat), existing easement deeds, and documents listed as exceptions in the title report, etc. ❑ Two (2) Draft Copies of any street dedications. ❑ Two (2) Draft Copies of Any New Easements or Restrictions being created by separate document, improvement agreements, maintenance agreements, joint use ingress/egress and utility easements, sewer hook up in lieu of assessment, and any other documents that will be recorded together with the plat or that are required by the Conditions of Approval. ❑ Two (2) Copies of a Consent Statement (Concurrence) on the plat (to be signed by the lender prior to final approval) OR Two (2) Copies of an Affidavit of Consent by separate document is required from all Trust Deed, mortgage, or other secured loan interest holders against the property to be recorded simultaneously with the plat IF any public dedications or easements are being made and/or any other interests are being transferred to the public per ORS 92.075 (2-4). ❑ Copies of Wetland Documents as required. ❑ Copies of ODOT Access Permits as required. ❑ Draft Copy of Bargain and Sale Deed for Reserve Strips - City Survey Section has a template. ❑ Verification that Street Tree Agreement is in Progress as required. ❑ Draft Copy of the Conditions, Covenants & Restrictions (CC&Rs) as required. Revised 10.14.13 kl 5 of 6 ❑ Post Monumentation Deposit as required for subdivisions only. City Survey Section has current fee schedule and templates. ❑ Location of Any Floodways in accordance with SDC 3.3-400. ❑ Existing Easements Clearly Identified with Their Recorded Reference. ❑ New Easements and Reserve Strips Referenced in Owner Certificates of Dedication and Purposes of Easements Identified on Plat. NOTE: When, as part of the approval process, the application has been conditioned so that the recordation of a document is required, the applicant shall be responsible for paying the Lane County recording fee for any such required document. Documents which may require recordation include, but are not limited to: Development Agreements; Improvement Agreements; Deed Restrictions; Future Development Plans; Easements; Joint Use Access/ Maintenance Agreements; and Dedications of Right -of -Way. Land Division Plat Submittal Requirements Checklist NOTE: If you feel an item does not apply, please state the reason why and attach the explanation to this form. ❑ Application Fee - refer to the Development Code Fee Schedule for the appropriate fee calculation formula. A copy of the fee schedule is available at the Development & Public Works Department. The application, technology, and postage fees, where applicable, are collected at the time of complete application submittal. ❑ Land Division Plat Application Form ❑ Two (2) Copies of the Deed ❑ Two (2) Copies of a Title Report issued within 30 days of the date Lane County will record the plat. ❑ Original Plat on Mylar with notarized owner(s) signature(s) and signed surveyor stamp. ❑ Copy of the Mylar on Bond Paper ❑ Original and Copy of all Required Documents with signatures where appropriate. Revised 10.14.13 kl 6 of 6 SPRINGFIELD �d OPE6RM Name of Plat: 404 18th LLC Partition Titles of required documents: 2r Original signed plat on acid free archivable bond paper (2 pages) Pi Original signed "Joint Use Access Easement Agreement' (3 pages) [2r Current Title Report ,O' Vesting Deed ❑ A copy of each of the previous,for Planning ❑ Final Plat Application From and Fee Sincerely, NOTE: The application is Only complete after you return: • 5 rolled copies of the recorded plat • 3 copies of documents recorded with plat ON Instructions: This form is to accompany the plat and the supporting documents in the Public Works Department of the City of Springfield at the time of final plat submittal. The purpose is primarily to notify the planning affice that the Surveying Division has received ell the documents it requires for final plat submittal. County Instructions:I' his form is to accompany the plat and the supporting documents to the Lane County Surveyor's Office at the time of final submittal for recording. The purpose is primarily to notify That allure of which items need to be recorded simolamem ely with the plat, but it also serves to remind The developer/surveyor that these documents need to be included in the final submittal package to The County Su ,e or. B use smon;aNppann cac T m,n:oelwmenxsllNetwenelo mancomlook aQvnrzv�ana 181 LLC Praiva, suemm9.auc. After recording, return to: Jessica Riggens 985 Hughes St. Eugene, OR 97402 JOINT ACCESS AND UTILITY EASEMENT MAINTENANCE AGREEMENT DECLARANT: 404 18th LLC EFFECTIVE DATE:lQ_. 'a 2021 RECITALS A. Declarant is the owner of certain real property described as Parcel 1 and Parcel 2 (collectively, the "Parcels ), Land Partition Plat No. 2021-P , as platted and recorded in the Lane County Official Records on , 2021, Reception No. 2021- (the "Plat") located in Lane County, Oregon. B. In anticipation of future separate ownership of the Parcels and in compliance with the conditions of City of Springfield Case Number 811-19-000297-TYP2, Declarant desires to provide for the shared use and maintenance of the concrete driveway within the 16.00 foot PRIVATE JOINT ACCESS AND UTILITY EASEMENT created by and shown on the Plat (the "Driveway"), and the 3' x 45' infiltration strip within the Driveway acting as the stormwater treatment facility (the "Storm Water Facility") for the stormwater runoff generated by the shared driveway. EASEMENTS NOW, THEREFORE, for valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Declarant declares as follows. 1. Use and Maintenance of the Driveway. F.ach Parcel owner shall have the right to the shared use of the Driveway for access to and from such owner's Parcel. The owners of the Parcels shall share equally in the cost of any maintenance, repair and replacement of the Driveway. 2. Use and Maintenance of the Storm Water Facility. The owners of Parcel 1 and Parcel 2 shall have the right to shared use of the Storm Water Facility for treatment of stormwater runoff from that portion of the shared access drive located on the individual Parcels. The owners of Parcel 1 and Parcel 2 shall maintain the Storm Water Facility in compliance with the Operations and Maintenance Plan on file with the City of Springfield and shall share equally in the cost of any maintenance, repair and replacement of the Storm Water Facility. 3. Restriction. No party may construct any structure in the 16.00 foot PRIVATE JOINT ACCESS AND UTILITY EASEMENT or obstruct access to the 16.00 foot PRIVATE JOINT ACCESS AND UTILITY EASEMENT for the purposes contemplated in this Agreement, except as temporarily necessary in the case of an emergency. 4. Indemnity. The owners of the Parcels indemnify, defend and hold each other harmless from and against all claims and losses arising out of or resulting from the indemnifying party's use of the Driveway or the Storm Water Facility. 5. Notices. All notices required or permitted to be given shall be in writing and shall be deemed given and received on personal service or deposit in the United States Mail, certified or registered mail, postage prepaid, return receipt requested, addressed to the owner of the relevant property at the then -current address for such owner shown on the Lane County Assessor's records. Such addresses may be changed by written notice, given in the same manner. Notice given in any manner other than the manner set forth above shall be effective when received by the party for whom it is intended. 6. Recording. Declarant shall promptly record this Agreement in the Official Records of Lane County. 7. Attorney Fees. If litigation is instituted with respect to this Agreement, the prevailing party shall be entitled to recover from the losing party, in addition to all other sums and allowable costs, its reasonable attorney fees, both in preparation for and at trial and any appeal or review, such amount to be set by the court before which the matter is heard. 8. Binding Effect. The covenants and restrictions contained herein run with the Parcels, including any future subdivision or partition thereof. This Agreement shall be binding on and inure to the benefit of the parties and their respective heirs, successors and assigns of the interest in the Parcels. Declarant intends this Agreement to continue and not merge and to remain appurtenant to and to benefit the Parcels. 9. No Waiver. Granting a waiver or failing to enforce a covenant or restriction contained herein in one or more instances shall not constitute a waiver of the right to enforce a covenant or restriction in the future. 10. Governing Law: Interpretation. This Agreement shall be governed by the laws of Oregon. If a court of competent jurisdiction holds any portion of this Agreement to be void or unenforceable as written, the Declarant and the owners of the Parcels intend that (1) that portion of this Agreement be enforced to the extent permitted by law, and (2) the balance of this Agreement remain in full force and effect. 11. Amendments. Any modifications, changes, additions, or deletions to this Agreement must be approved by both the owners of all of the Parcels, in writing. 12. Termination. The obligations contained in this Agreement shall terminate only upon mutual written agreement among the owners of all Parcels. Executed as of the day and year first above written. DECLARANT: 404 18[11 LLC By: da Jessi Rrggen, Member 40 8`", LLC STATE OF OREGON ) ss. County of Lane ) On L Np�)) , 2021, personally appeared the above-named, Jessica Riggen, being known to me or proven to me by satisfactory evidence to be the same person who executed the foregoing instrument, in her authorized capacity as a Member of 404 18t11, LLC and she acknowledged the same to be her voluntary act and deed. Before me: -�` "° it o r•si Notwy Public for Oregon �^ ,n 2 My commission expires: JmIYA wr, P51 ANCAI. i 7.1 3 MR ���_ After recording return to: 404 18th LLC 2450 Birch Ln Eugene, OR 97403 Until a change is requested all tax statements shall be sent to the following address: 404 16th LLC 2450 Birch Ln Eugene, OR 97403 File No.: 7191-3223145 (RM) Date: May 01, 2019 Lane County Clerk 2019-017086 Lane County Deeds & Records 05/03/2019 03:03:53 PM RPR -DEED Cnt=l Sin=40 CASHIER 01 3pages $15 00 $11 00 $10.00 $61.00 $97.00 STATUTORY WARRANTY DEED David Charles Johnson and Peggy Lynn Streeter, not as tenants in common, but with the right of survivorship, Grantor, conveys and warrants to 404 18th LLC , Grantee, the following described real property free of liens and encumbrances, except as specifically set forth herein: LEGAL DESCRIPTION: Real property in the County of Lane, State of Oregon, described as follows: THE SOUTH 52 FEET OF LOT 14 IN THE H L & T B STEWART'S PLAT OF ACREAGE LOTS, AS PLATTED AND RECORDED IN LANE COUNTY, OREGON PLAT RECORDS, BOOK 3, PAGE S. Subject to: 1. Covenants, conditions, restrictions and/or easements, if any, affecting title, which may appear in the public record, including those shown on any recorded plat or survey. The true consideration for this conveyance is $90,000.00. (Here comply wren requiremenrs of ORS 93.030) Page 1 of 3 APN: 0329637 Statutory Warranty Deed File No.: 7191.3713163 IRM) -=dnued BEFORE SIGNING OR ACCEPTING THIS INSTRUMENT, THE PERSON TRANSFERRING FEE TITLE SHOULD INQUIRE ABOUT THE PERSON'S RIGHTS, IF ANY, UNDER ORS 195.300, 195.301 AND 195.305 TO 195.336 AND SECTIONS 5 TO 11, CHAPTER 424, OREGON LAWS 2007, SECTIONS 2 TO 9 AND 17, CHAPTER 655, OREGON LAWS 2009, AND SECTIONS 2 TO 7, CHAPTER 8, OREGON LAWS 2010. THIS INSTRUMENT DOES NOT ALLOW USE OF THE PROPERTY DESCRIBED IN THIS INSTRUMENT IN VIOLATION OF APPLICABLE LAND USE LAWS AND REGULATIONS. BEFORE SIGNING OR ACCEPTING THIS INSTRUMENT, THE PERSON ACQUIRING FEE TITLE TO THE PROPERTY SHOULD CHECK WITH THE APPROPRIATE CITY OR COUNTY PLANNING DEPARTMENT TO VERIFY THAT THE UNIT OF LAND BEING TRANSFERRED IS A LAWFULLY ESTABLISHED LOT OR PARCEL, AS DEFINED IN ORS 92410 OR 215.010, TO VERIFY THE APPROVED USES OF THE LOT OR PARCEL, TO DETERMINE ANY LIMITS ON LAWSUITS AGAINST FARMING OR FOREST PRACTICES, AS DEFINED IN ORS 30.930, AND TO INQUIRE ABOUT THE RIGHTS OF NEIGHBORING PROPERTY OWNERS, IF ANY, UNDER ORS 195.300, 195.301 AND 195.305 TO 195.336 AND SECTIONS 5 TO 11, CHAPTER 424, OREGON LAWS 2007, SECTIONS 2 TO 9 AND 17, CHAPTER 855, OREGON LAWS 2009,1,,AND SECTIONS S 2 TO 7, CHAPTER 8, OREGON LAWS 2010. (n� Dated this// day of ITvNI, 2D�� David Charles Johnson Peggy n feet. STATE OF Oregon ) )ss. County of Lane ) This Instrument was acknowledged before me on this ✓ day of M CA' _, 201 by David Charles Johnson OFFICIAL STAMP ✓ ^ ^� RENEE OBINNE MAEL Notary Public for Oregon ,�(} NOTARY PUBLIC -OREGON My commission expires: - COMMISSION NO.966360 MY COMMISSION EXPIRES SEPTEMBER 05, 2021 Page 2 of 3 APN:0329837 Rad ryWarranly Deed His No, 7191.3273195 fRM) -coi nued STATE OFirJG&�• J�^ 1 s County of �',lat1, tvt sk tt cc�� This Instrument was acknowledged before me on this day of'� by Peggy Lynn Streeter. TANYA M KERFtf Notary Public State of Washington My commission Expires April 23, 2022 Page 3 of 3 CI-. LwIK, -v �r c"ti expires: �.Z3-ZZ_ We are prepared to issue on request and on recording of the appropriate documents, a policy or policies as applied for, with coverage's as indicated, based on this preliminary report. LEGAL DESCRIPTION: The South 52 feet of Lot 14 in the H.L. & T. B. STEWARTS PLAT OF ACREAGE LOTS, as platted and recorded in LANE COUNTY OREGON PLAT RECORDS, BOOK 3, PAGE 5 Showing fee simple title as of November 29, 2021, at 8:00 a.m., vested in: 404 18th LLC Subject only to the exceptions shown herein and to the terms, conditions and exceptions contained in the policy form. No liability is assumed until a full premium has been paid. Order No.: 21-24147 Page 1 of 3 A, 911 CountryClub Club Rd, Ste 320 Rd, •Eugene, OR 97401 260 Country Club Ste 1211 • Eugene, OR 97401 Phone Phone: W P.O.3 . Box 1020 Eugene •Eugene, OR 97440 Fax 541.741.0619 Phone: 541.687.9794 Fax 541.687.0924 Evergreen TITLE INSURANCE SERVICES • ESCROW CLOSINGS December 02, 2021 Order No. 21-24147 7st SUPPLEMENTAL TITLE REPORT Jack Hough Partial Billing $300.00 925 Ascot Or Additional Chain Eugene, OR 97401 ($300.00) Attn: Jack Hough Paid on Account $0.00 e-mail: njhough@comcast.net TOTAL Dear Jack Hough: We are prepared to issue on request and on recording of the appropriate documents, a policy or policies as applied for, with coverage's as indicated, based on this preliminary report. LEGAL DESCRIPTION: The South 52 feet of Lot 14 in the H.L. & T. B. STEWARTS PLAT OF ACREAGE LOTS, as platted and recorded in LANE COUNTY OREGON PLAT RECORDS, BOOK 3, PAGE 5 Showing fee simple title as of November 29, 2021, at 8:00 a.m., vested in: 404 18th LLC Subject only to the exceptions shown herein and to the terms, conditions and exceptions contained in the policy form. No liability is assumed until a full premium has been paid. Order No.: 21-24147 Page 1 of 3 SCHEDULE B GENERAL EXCEPTIONS 1. Taxes or assessments which are not shown as existing liens by the records of any taxing authority that levies taxes or assessments on real property or by the public records; proceedings by a public agency which may result in taxes or assessments, or notices of such proceedings, whether or not shown by the records of such agency or by the public records. 2. Facts, rights, interests or claims which are not shown by the public records but which could be ascertained by an inspection of the land or by making inquiry of persons in possession thereof. 3. Easements, or claims of easement, not shown by the public records; reservations or exceptions in patents or in Acts authorizing the issuance thereof, water rights, claims or title to water. 4. Discrepancies, conflicts in boundary lines, shortage in area, encroachments or other facts which a correct survey would disclose. 5. Any lien, or right to a lien, for services, labor, material, equipment rental or workers compensation heretofore or hereafter furnished, imposed by law and not shown by the public records. CURRENT EXCEPTIONS: 6. Taxes, Mao No. 17-03-36-24-01700, Code 19-00, Account No. 0329837, as follows: 2021-2022, a lien in the amount of $1,278.86, plus interest is unpaid. 2020-2021, a lien in the original amount of $923.74, of which $8.10, plus interest is unpaid. 7. Right -of -Way -Easement, granted to City of Springfield, including the terms and provisions thereof, by instrument Recorded August 14, 1950, Reception No. 26034, Lane County Oregon Records. 8. Right of Way Overhead Easement, granted to the City of Springfield, a municipal corporation, acting by and through its Springfield Utility Board, including the terms and provisions thereof, by instrument Recorded August 25, 2008, Reception No. 2008-048588 Lane County Oregon Records. NOTE: The address of the property to be insured herein is: 404 18th St., Springfield, OR 97477. NOTE: A Judgment/Lien/Bankruptcy Search was done for the name(s) 404 18th LLC, and as of November 29, 2021, none were found. NOTE: As of November 29, 2021, there are no liens for the City of Springfield. NOTE: SUPPLEMENTED TO UPDATE REPORT TO ADD NEW TAXES AND MISSED EASEMENT. Order No.'. 21-24147 Page 2 of 3 NOTE: Due to current conflicts or potential conflicts between state and federal law, which conflicts may extend to local law, regarding marijuana, if the transaction to be insured involves property which is currently used or is to be used in connection with a marijuana enterprise, including but not limited to the cultivation, storage, distribution, transport, manufacture, or sale of marijuana and/or products containing marijuana, the Company declines to close or insure the transaction, and this Preliminary Title Report shall automatically be considered null and void and of no force and effect. Very truly yours, EVERGREEN LAND TITLE COMPANY HOME OFFICE By: Joseph M Silence Title Officer/ Title Manager cc: Poage Engineering NO LIABILITY IS ASSUMED HEREUNDER UNTIL POLICY IS ISSUED AND PREMIUM PAID. IF FOR ANY REASON THE REPORT IS CANCELLED, A MINIMUM CANCELLATION FEE OF $200.00 WILL BE CHARGED. Order No.: 21-24147 Page 3 of 3 R m I , I p � , 1 ms IS O 1� I I 1 I 1 6 �m tl W bf bA � r 98 LS SA tS 8C OZ Q 14 -------------- N 1 ~ tD I 1 o i� M 1 mp op a I es A6 � Kaaon 1169 L ZC � � AZ: v �4 rP 9¢M .SG➢u4 A S9 ug aQ 3 V� a s O vfi.. .6E K 6EbAI � t M M N M. C � A9 W N 43� t t L a___EtiL__ O/ 'W 6'ci 0 us fl Zs Q) Zjg -- R'Q O O be W m, KQ¢ O Ia a D O !O OU tpn o In p C N�� F > > V WNW '. � 1 I SEW de 3B'Ji1{iUN f 3.ZIF60N m I rpJ.^ � Privacy Policy Notice As adopted July 1; 2001 Evergreen Land Title Company Private Policy Notice PURPOSE OF THIS NOTICE Title V of the Gramm -Leach -Bliley Act (GLSA) generally prohibits any financial institution, directly or throughits affiliates, from sharing nonpublic personal information about you with a nonaffiliated third party unless the institution provides you with a notice of its privacy policies and practces, such as the type of information that it collects about you and the categories of persons or entities to whom it may be disclosed. In compliance with the GLBA, we are providing you with this document, which notifies you of the privacy policies and practices of Evergreen Land Title Company. We may collect nonpublic Personal information about you from the following sources: • Information we receive from you, such as on applications or other forms_ • Information about your transactions we secure from ourfilss, or from our affiliates or others. • Information we receive from a consumer reporting agency. • Information that we receive from others involved in your transaction, such as the real estate agent or ender. Unless it is specifically stated otherrnse in an amended Privacy Policy Notice, no additional nonpublic personal information will be collected about you - We may disclose any of the above information that we collect about our customers or former customers toour affiliates or to nonaffiliated third parties as permitted by taw. We also may disclose this information about our customers or former customers to the following types of nonaffiliated companies that perform marketing services on our behalf or with whom we have joint marketing agreements: • Financial service providers such as companies engaged in banking, consumer finance, securities and insurance. • Non-financial companies such as envelope stutters and other fulfillment service providers_ WE DO NOT DISCLOSE ANY NONPUBLIC PERSONAL INFORMATION ABOUT YOU WITH ANYONE FOUR ANY PURPOSE THAT IS NOT SPECIFICALLY PERMITTED BY LAWS. We restrict access to nonpublic ;personal information about you to those employees who need to know that information in order to provide products or services to your We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard yournonpublic personal information.