Fill and Sign the Water Easement Form

_______________________________________________________________________________________________________ Space Above This Line for Recording Data STATE OF GEORGIA COUNTY OF __________________ STORM WATER DRAINAGE AND UTILITY EASEMENT THIS INDENTURE made and entered into this day of __________________ ___ , 20 ___ , by and between                                                 , herein referred to as “Grantor”, and                                     COUNTY, GEORGIA, a political subdivision of the State of Georgia, herein referred to as “County”. W I T N E S E T H: THAT, Grantor, for and in the consideration of the sum of _______________ ($ ___ .00) Dollars, in hand paid by the County, the receipt and adequacy of which is hereby acknowledged by the Grantor, does hereby grant, bargain, sell and convey to the County, its successors, and assigns, a permanent easement for the purpose of constructing, maintaining, using, operating, repairing and reconstructing storm water drainage facilities and any other utility lines or facilities over, under and across the following described property, to wit: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 1 _____________________________________________________________________ _____________________________________________________________________ LEGAL DESCRIPTION (Include, Lot, Block, Subdivision) These easements include the right of ingress thereto and egress therefrom, for any and all purposes connected with the proper construction, maintenance, use, operation, repair and reconstruction of said storm water drainage facilities and other utility lines or facilities over surrounding property of the Grantor along a route designated by the Grantor which does not unreasonably interfere with the performance of the work needed in the easement. Grantor shall not construct any improvement within the area of the easement, and shall plant only grass and small shrubs within the area of the easement. After completing work within the area of the easement, the County shall.backfill as necessary any trenches (excluding drainage ditches) to the level of the abutting ground and replace any grass or shrubs removed to the extent reasonably practicable. IN WITNESS WHEREOF, Grantor does hereunto set his/her hand and seal on the day and year above written. __________________________________ SIGNED, SEALED AND DELIVERED in the presence of: __________________________________ Witness __________________________________ Notary My Commission Expires: ___________ Accepted and approved on behalf of ____________________ County Board of Commissioners, and incorporated as part of the storm water drainage system or such other utility system of ____________________ County, This _____ day of ________________ , 20 _____ . _______________________ County, Georgia By: _______________________________ 2 Attest: _______________________________ My Commission Expires: ___________ 3