Fill and Sign the This Deed of Easement is Made Thisday of 200 Form

1THIS DEED OF EASEMENT is made this day of , 20 , by and between (hereinafter referred to as “Owner”); and , VIRGINIA, a Virginia Municipal Corporation (hereinafter referred to as “Town”). W I T N E S S E T H:WHEREAS, the Owner is the owner and proprietor of certain real property situate in theTown of , Magisterial District,  County, Virginia, identified as Tax Parcel , as shown on a plat entitled, , drawn by , Document No. , dated (the “Plat”); WHEREAS, Owner acquired the property by deed recorded in Deed Book , at page , among the land records of County, Virginia; and WHEREAS, it is the desire and intent of the Owner to grant and convey unto the Town the easements in the locations as shown on the Plat and as hereinafter provided;NOW THEREFORE, in consideration of the premises and the sum of , cash in hand paid, receipt of which is hereby acknowledged, Owner does hereby dedicate to the Town, its successors and assigns, the following easements: Temporary Construction Easemen t. A temporary easement for the purpose of the necessary construction of public utilities, consisting of acres, as depicted and described on the Plat. This temporary construction easement shall become null and void at such time as the construction is complete. The Town shall restore the Easement Area as nearly as possible to its pre-construction condition at the conclusion of the construction. Exemption is claimed under Section 58.1-811(A)(3), Code of Virginia (1950), as amended.Public Utility Easement. A public utility easement consisting of acres, as depicted and described on the Plat for the construction, operation, maintenance, alteration or replacement of public utility facilities. The foregoing easements are subject to the following conditions:1. The Town shall have full and free use of said easements for the purposes stated, and shall have all rights and privileges reasonably necessary to the exercise of the easements including the right of access to and from the easement area.2. Town shall have the right to trim, cut, and remove trees, shrubbery, fences, structures, or other obstructions or facilities in or near the easements being conveyed, deemed by it to interfere with the proper and efficient construction, operation, and maintenance of said public utilities; provided, however, that Town at its own expense shall restore as nearly as possible, to their original condition, all land or premises included within or adjoining said easements which are disturbed in any manner by the construction, operation, and maintenance of said public utilities. Such restoration shall include the backfilling of 2trenches, the replacement of fences and shrubbery, the reseeding or re-sodding of lawns or pasture areas, and the replacement of structures and other facilities located without the easements, but shall not include the replacement of structures, trees, and other facilities within the easements.3. Owner reserves the right to make use of the easement areas herein granted which may not be inconsistent with the rights herein conveyed or interfere with the use of said easements by the Town for the purposes named; provided, however, that Owner shall not erect any building or other structure on the easement area without the prior written approval of Town.IN WITNESS WHEREOF, the parties hereto have caused this Deed to be executed,under seal. (SEAL).ACCEPTED: TOWN OF By: (SEAL)Title: Approved as to form: Town AttorneyCOMMONWEALTH OF VIRGINIACOUNTY OF The foregoing deed of easement was acknowledged before me by , Owner, this day of , 20 . Notary PublicMy Commission Expires: COMMONWEALTH OF VIRGINIACOUNTY OF The foregoing deed of easement was acknowledged before me by , for the Town of , Virginia, on behalf of the Town, this  day of , 20 . Notary PublicMy Commission Expires: