HomeMy WebLinkAboutRecording and Statement of Intent (BLA) - writable
AFTER RECORDING MAIL TO:
Name:
Address:
City/State:
Boundary Line Adjustment
Grantor(s):
1.
2.
Grantee(s):
1.
2.
Legal Description: Parcels involved in the adjustment are currently legally described as follows (include Assessor’s
Property Tax Parcel Account Numbers):
Parcel A:
Parcel B:
Parcel C:
Parcel D:
Boundary line subject to adjustment described as follows (new legal description):
The nature of the adjustment is described as follows:
STATEMENT OF INTENT:
This recording is for the purpose of assisting with a boundary line adjustment pursuant to RCW
58.17.040(6). It does not create any additional lots, tracts, parcels, or division as the land
described herein shall merge or be integrated into abutting property presently owned by the
proponent. Nor does the boundary line adjustment result in any lots, tracts, parcels, or division
which contain insufficient area and dimension to meet minimum County and sanitation
requirements for width and area for a building site.
(Proponents’ signature)
STATE OF WASHINGTON
COUNTY OF JEFFERSON
On , 20___, personally appeared
___________________________________________ and proved to me on the basis of
satisfactory evidence to the person whose name is subscribed to this instrument, and
acknowledged that she executed it.
WITNESS my hand and official seal this ___ day of ____, 20___ .
Notary Public in and for the State of Washington,
Residing at
This boundary line adjustment has been reviewed and approved by the Jefferson County
Development Review Division.
Associate/Assistant Planner Date