Design & Construction Specifications - Town of Kernersville

Date:_______________, 20__TO:Russell RadfordWatershed AdministratorTown of KernersvilleFROM: ______________________________Owner of Subject PropertySUBJECT PROPERTY: Approximate Acreage:____________________Tax Block(s):__________ Lots(s):__________Deed Book Reference: Book:___________, Page:__________The undersigned being the owner, or agent of owner, of the above-stated property hereby requeststhe Watershed Administrator to make a determination regarding Common Law Vesting in the development ofsaid property.Pursuant to such request for determination, the undersigned submits herewith, in affidavit form, thefacts to date surrounding ownership and development, which the undersigned believes entitles the owner ofsaid subject property to a determination that the owner (undersigned) is vested by common law fordevelopment purposes outside the purview of the current Town of Kernersville Watershed Ordinance.The undersigned recognizes that information that should be made a part of the accompanying affidavitincludes date(s) of purchase; specific types of development, with dates and costs of development(accompanied by checks, receipts, or other appropriate evidence of payments); a description of how costsincurred in the development apply to each distinct portion, or phase, of the development; any written or draftedplans, with date(s) whether or not submitted to any regulatory agency of the State, County, or Town ofKernersville staff, agency or Board. The undersigned acknowledges that such affidavit may include all suchother explanations as owner feels will assist the Watershed Administrator in making determination as toCommon Law Vesting and the same is contained in the attached affidavit and accompanying documentation.Submitted the day and year first above written by:__________________________________Owner, or__________________________________Agent for:__________________________________REPRODUCIBLE FORM