Legal Description:

Declaration:

The owner in fee simple of the land herein described is ______________________. The owner does hereby establish a Binding Site Plan for the purpose of lease of portions thereof, pursuant to RCW Chapter 58.17 and Title 18 of the George Municipal Code and that the undersigned declares that development of the property herein described shall conform to all inscriptions contained hereon.

___________________________

Signature

___________________________

Date

Acknowledgment:

State of Washington

County of Grant

I certify that I know or have satisfactory evidence that ____________________________signed this instrument and acknowledged it to be his/her free and voluntary act for the uses and purposes mentioned in the instrument.

Dated _______________________

(Seal)

____________________________

Notary Public

_________________________

Print or Type Name of Notary Public

My appointment expires ________________________

Land Surveyor's Declaration:

I hereby certify that this Binding Site Plan is a true and correct representation of the lands actually surveyed.

I hereby declare that the Binding Site Plan ____________________________, the heretofore described tract of land, is based upon an actual survey and that all the distances and courses shown thereon are correct to the best of my knowledge, information, and belief; and that I have fully complied with the provisions of the statues and platting regulations.

____________________________

Professional Land Surveyor

Certificate No._________________________

Approvals:

Examined and approved by the George Mayor on ______________________, 19___.

____________________________

Mayor

Filed for the record at the request of the City of George this day _____ of ___________________, 19___, in Volume of the Book of Surveys, on page ________, records of Grant County, Washington.

___________________________

Grant County Auditor

____________________________

by Deputy Auditor