Fillable REDUCED SETBACK AGREEMENT (Minnesota Department of Revenue)

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REDUCED SETBACK AGREEMENT (Minnesota Department of Revenue)

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Effective 01/01/2019
REDUCED SETBACK AGREEMENT
THIS AGREEMENT IS MADE AND ENTERED INTO this ______ day of __________,
20____, by and between owners of TRACT
A, as described below, on which a sewage treatment system is being installed with a
reduced setback, hereinafter referred to as the “Applicant,” and
____________________________, owners of TRACT B, as described below, which is
the property adjacent to, and affected by, the sewage treatment system being installed
with a reduced setback, hereinafter referred to as “Adjacent Property Owner.”
LEGAL DESCRIPTIONS
TRACT A – PARCEL IDENTIFICATION NUMBER _____________________________
TRACT A – LEGAL DESCRIPTION
TRACT B – PARCEL IDENTIFICATION NUMBER _____________________________
TRACT B – LEGAL DESCRIPTION
WHEREAS, the Stearns County Environmental Services Department may reduce the
property line setback due to site conditions provided the Applicant and Adjacent
Property Owner agree as to location of the property line, and further that the Adjacent
Property Owner has no objection to placing the sewage treatment system with a
reduced setback.
Effective 01/01/2019
NOW THEREFORE, the parties agree as follows:
1. That the Applicant and Adjacent Property Owner are in agreement as to the
location of the property line and that the sewage treatment system may be placed
_____ feet from the property line. The location of the system is shown on the
attached diagram, which shall show the property line, nearby structures, and the
location of the system.
2. That this agreement shall only apply to the installation and operation of the
sewage treatment system scheduled to be installed on or about
___________________________, as approved by Stearns County Environmental
Services Permit _______________.
3. Should the sewage treatment system require future replacement, a review of
site conditions should occur to determine the location of a future sewage treatment
system. Should installation be necessary in the same location, or another location
requiring a reduced setback, a new agreement between the then property owners
shall be necessary.
IN WITNESS THEREOF the parties have executed this Agreement on the date and year
first above written.
APPLICANT(S):
Applicant Signature Applicant Signature
State of Minnesota }
County of _________ }
The foregoing instrument was acknowledged before me this _______ day of
________________, 20____ by ____________________________________________
___________________________
Signature of Notary
Effective 01/01/2019
State of Minnesota }
County of _________ }
The foregoing instrument was acknowledged before me this _______ day of
________________, 20____ by ____________________________________________
___________________________
Signature of Notary
ADJACENT PROPERTY OWNER(S):
Adjacent Property Owner Signature Adjacent Property Owner Signature
State of Minnesota }
County of _________ }
The foregoing instrument was acknowledged before me this _______ day of
________________, 20____ by ____________________________________________
___________________________
Signature of Notary
State of Minnesota }
County of _________ }
The foregoing instrument was acknowledged before me this _______ day of
________________, 20____ by ____________________________________________
___________________________
Signature of Notary
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REDUCED SETBACK AGREEMENT (Minnesota Department of Revenue)

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Completed 18 July 2020

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