ORDER NO.29419
APPROVAL OF ENCROACHMENT OF SEPTIC SYSTEM
DRAINFIELD LINES, LOT 15, CEDAR RIDGE SUBDIVISION
Came to be heard this the 11th day of October, 2005, with a motion made by
Commissioner Baldwin, seconded by Commissioner Letz. The Court
unanimously approved by vote of 4-0-0 to:
Approve the encroachment of septic system drainfield lines into 7' recorded
utility easement on Lot 15 of Cedar Ridge Subdivision.
~~~
a q~llq
COMMISSIONERS' COURT AGENDA REQUEST
PLEASE FURNISH ONE ORIGINAL ANII TEN COPIES OF THIS
REQUEST AND DOCUMENTS TO BE REVIEWED BY THE COURT.
MADE BY: Miguel Arreola
MEETING DATE: October 12, 2005
OFFICE: Environmental Health
TIME PREFERRED: 9:30
SUBJECT: As requested by property developer, Discussion and approval of
encroachment of septic system drainfield lines into 7' recorded utility easement at lot 15
of Cedar Ridge subdivision.
EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON)
NAME OF PERSON ADDRESSING THE COURT:
ESTIMATED LENGTH OF PRESENTATION:
IF PERSONNEL MATTER -NAME OF EMPLOYEE:
Time for submitting this request for Court to assure that the matter is posted in
accordance with Title 5, Chapter 551 and 552, Government Code, is as follows:
THIS REQUEST RECEIVED BY:
THIS REQUEST RECEIVED ON:
All Agenda Requests will be screened by the County Judge's Office to determine if adequate
information has been prepared for the Court's formal consideration and action at time of Court
Meetings. Your cooperation will be appreciated and contribute towards you request being
addressed at the earliest opportunity. See Agenda Request Rules Adopted by Commissioners'
Court.
Meeting scheduled for Mondays:
5:00 P.M. previous Tuesday.

Supporting Information
Mr. Kenny Bledsoe, of Bledsoe General Contracting has acquired approval of
encroachment from the following utility companies:
Kerrville Public Utility board
Kerrville South Water Company
Time Warner Cable
Kerrville Telephone Company
Please note that the )/ncroachment Consent does not release the utility companies from
doing work in the easement and does not hold the utility company liable for any damages
the utility company may do to septic lines as a result of such work.
The utility easement was originally recorded and approved by Commissioner's Court on
Apri18, 1974 by order No 12104.
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r ~nq r!~ ~ ~w rndr-d peal, cl~ SURVEY PLAT OF LOT 15, CEDAR RIDGE, A SUBDIVISION OF
KERR COUNTY, TEXAS, RECORDED IN VOLUME 4, PAGE 4,
PLAT RECORDS OP KERR COUNTY, TEXAS.
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RECORD BEARING BASIS HELD:
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Bledsoe General Contracting, Inc.
P.O. Box 290845 Kerrville, Texas 78029-0845
Office: (830) 896.8845; Fax (830) 896.1991; "email: Bledsoe@ktc.com
October 3, 2005
To: Kerr County Environmental Health Dept. (Fax: 792.4903)
Attn: Miguel
Re: 411 Alvin Drive septic Consent to Encroach
In reference to the above named property, we are submitting approval through Consents to
Encroachment by all utilities: Kerrville Public Utility Board, Kerrville South Water Company,
Time Warner Cable, and Kerrville Telephone Company.
Please be advised that this completes the requested approval information needed in order to
submit this to the Commissioner's Court meeting for October 11`". Time is of the essence in
settling this matter and your cooperation is appreciated.
Should you have any other questions, please feel free to contact me at the above listed phone
number.
Thank you for your prompt attention.
Sincerely,
er Lynn Bledsoe, Vice-President
Bledsoe General Contracting, Inc.
Encl: Consent to Encroachment from KPUB, KTC, Kerrville South Water, Time Warner Cable
I •- f ~~
1
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.~_. J 3 ~ l
Y _ _~_. _
CONSENT TO ENCROACHMENT ? OCT ~ 3 ZQ05
THE STATE OF TEXAS § ~ ~ ~~
§ KNOW ALL MEN BY THESE PRESEIVT~~ ?~°~
COUNTY OF KERB § - ~ Y - -
That by instrument recorded in Volume 4, Page 4, of the Plat Records of Kerr County, Texas, a certain easement
and easement rights more particularly described in Exhibit A, attached hereto and made a part hereof for all
purposes (collectively the "Easement") were created, reserved or granted in favor of the Kerrville South Water
Company being the undersigned owner and beneficiary thereof ("Owner", whether one or more) across the
property which is more particularly described in Exhibit A (the "Property").
NOW, THEREFORE, Owner, have this day and do by these presents CONSENTS:
A. To the existing building encroachment into Easement as reflected on the survey plat attached
hereto and made a par[ hereof for all purposed as Exhibit B; and,
B. To the maintenance, repair and reconstruction of any such improvements; PROVIDED,
HOWEVER, that any such reconstruction of improvements shall not result in an expansion of said
existing encroachments or in any additional encroachments within the Easement; and PROVIDED
FURTHER, that if any improvements existing within the Easement at the time of execution ofthis
Consent to Encroachment are destroyed, demolished, or otherwise removed from the property such
that the existing encroachment is abated, reconstruction of any improvements shall not encroach
into the Easement.
In consideration of the consent granted above by Kerrville South Water Company, the undersigned KENNETH
BLEDSOE AND JENNIFER BLEDSOE, for themselves and their successors in title to the Property, agrees, to
release, indemnify, and hold harmless, KERRVILLE SOUTH WATER COMPANY, ITS OFFICERS,
EMPLOYEES, AGENTS AND CONTRACTORS, from any damage to any improvements encroached within the
easement as the result of the installation, maintenance, repair, or replacement by KERRVILLE SOUTH WATER
COMPANY, ITS OFFICERS, EMPLOYEES, AGENTS AND CONTRACTORS, of any utility facilities, located
or to be located within the Easement, WHETHER OR NOT SUCH DAMAGE IS THE RESULT OF THE
NEGLIGENT ACT OR OMISSION OF KERRVILLE SOUTH WATER COMPANY, ITS OFFICERS,
EMPLOYEES, AGENTS OR CONTRACTORS.
EXECUTED THIS 3 ~6 DAY OF ~C~j(/~tr , 2005
Kerrville South ,ter Company:
sy:
Name• S-)-2J~Q Nou~q,RQ
Title• ~ r,e5 i ~Fx.f
Owners:
By:
Kenneth Bledsoe
By:
Jennifer Bledsoe
ACKNOWLEDGMENT
THE STATE OF TEXAS
COUNTY OF KERB
This instrument was acknowledged before me this ~ r~
2005, by(Name&Title) ,,rj-~-~~ ~-~p~~t,r~r,Q,
of Kerrville South Water Company, for and on behalf of
_~ I
:.
OCT 0 3 2005
Kerrville South Water Company.
Notary Pu ic, State of Texas
~», BARBARA 81NGHAM
1' " MV COMMISSION EXPIRES
~~+ JANUARY 30. 200
Typed or printed name
Notary commission expires
THE STATE OF TEXAS §
COUNTY OF KERR §
day of GL~U{~je.~ ,

ACKNOWLEDGMENT
This instrument was acknowledged before me this ~ day of
2005, by Kenneth Bledsoe and Jennifer Bledsoe
~..
;'~`~'•~ : B.E. VERHELBT
r rbun ~,ak, srro a T~xa~
~: *' MY CanmRsion Expiry
~~ JANUARV28,2008
:....
U~~
~~~~~~.~s7-
Notary Public, State of Texas
Typed or printed game
_ ~' ~~
Notary commission expires

OCT 0 3 2005
EXHIBIT "A" ~ `
T ; ~--.g e
PROPERTY: All that certain tract or parcel of land, lying and being situated in the Count o ~~rr,-State
of Texas and being Lots 14 and 15 Cedar Ridge Subdivision, a subdivision of Kerr County, Texas
according to the plat of said subdivision recorded in Volume 4, Page 4, Plat Records of Kerr County
Texas
	~" ~ "- iy OPPd RPi OIt]S		SC~II I" DU ~'
	. ~~ ~ ;'~Iti PI01 RM OIAS		
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	,,~ ;•."u.nq u;;n/o; Dawn; r , au ,n
r,q„7 opal ri,	
SURVEY PLAT OF LOT 16, C	
EDAR RIDGE, A SUBDIVISION OF
		KERR COUNTY, TEXAS, RE	CORDED IN VOLUME 4, PAGE /.
		PUT RECORDS OF KERR COUNTY, TEXAS.
			
	1
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!Of AR' •y S 06'54'01' E	
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		04 IIPl:32'-
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RECORD BEARING BASIS HELD:
N 04'33'00' W BETWEEN SURVEY
' MONUMENTS FOUND AT THE SW
CORNER OF LOT 14 AND THE NW
i CORNER OF LO7 15
'.4.
3
// JI/r
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G3C~G3G3~'I0~L~C~
pMC3d0C~
M4~drJ417
C30LlC~3D
2250 Memorial Blvd. P.O. Box 294999 Kerrville, Texas 78029-4999 830-257-3050 FAX 830-257-8078
September 14, 2005
Kenneth R. Bledsoe
P.O. Box 290845
Kerrville, Texas 78029-0845
RE: Consent to Encroachment
411 Alvin Dr.
Dear Mr. Bledsoe:
Please find enclosed a KPUB utility easement Consent to Encroach document
recognizing the existence of a structure within an utility easement. Certain stipulations
within the document require acknowledgment by the owner of the property.
Please review the same, sign it before a notary public in the space provided, record it at
the Kerr County courthouse, and return a recorded copy to our office.
Please call our office if you need further assistance in S~iis matter.
Sincerely,
Tracy L. McCuan, P.E.
Chief System Engineer
TLM/nlm
Attachments
- __ .::: i~ ~ -
UC ( U ;i 7n(15

CONSENT TO ENCROACHMENT
THE STATE OF TEXAS §
§ KNOW ALL MEN BY THESE PRESENTS:
COUNTY OF KERB §
That by instrument recorded in Volume 4, Page 4, of the Plat Records of Kerr County, Texas, a certain
easement and easement rights more particularly described in Exhibit A, attached hereto and made a part
hereof for all purposes (collectively the "Easement") were created, reserved or granted in favor of the
Kerrville Public Utility Board being the undersigned owner and beneficiary thereof (COwner", whether
one or more), across the property which is more particularly described in Exhibit A (the "Property").
NOW, THEREFORE, Owner, have this day and do by these presents CONSENTS:
A. To the existing building encroachment into Easement as reflected on the survey plat
attached hereto and made a part hereof for all purposes as Exhibit B; and,
B. To the maintenance, repair and reconstruction of any such improvements; PROVIDED,
HOWEVER, that any such reconstruction of improvements shall not result in an
expansion of said existing encroachments or in any additional encroachments within the
Easement; and PROVIDED FURTHER, that if any improvements existing within the
Easement at the time of execution of this Consent to Encroachment are destroyed,
demolished, or otherwise removed from the property such that the existing encroachment
is abated, reconstruction of any improvements shall not encroach into the Easement.
In consideration of the consent granted above by the Kerrville Public Utility Board, the undersigned
KENNETH BLEDSOE AND JENNIFER BLEDSOE, for themselves and their successors in title to the
Property, agree to release, indemnify, and hold harmless, the KERRVILLE PUBLIC UTILITY BOARD, ITS
OFFICERS, EMPLOYEES, AGENTS AND CONTRACTORS, from any damage to any improvements
encroaching within the Easement as the result of the installation, maintenance, repair or replacement by
the KERRVILLE PUBLIC UTILITY BOARD, ITS OFFICERS, EMPLOYEES, AGENTS AND
CONTRACTORS, of any utility facilities, located or to be located within the Easement, WHETHER OR
NOT SUCH DAMAGE IS THE RESULT OF THE NEGLIGENT ACT OR OMISSION OF THE KERRVILLE
PUBLIC UTILITY BOARD, ITS OFFICERS, EMPLOYEES, AGENTS OR CONTRACTORS.
EXECUTED THIS~DAY OF ~Eyi.SF~' , 20 D S.
'~ ~ Kerrvilly~ lic Utility Board
By: •~~~j{c.
k- ....._-__. __...
OCT 0 3 2005
Chief System Engineer
. _ ..~,..
Name: Tracy L. McCuan
ACKNOWLEDGMENT
THE STATE OF TEXAS §
COUNTY OF KERR §
This instrument was acknowledged before me this ~~ay of 20~, by
Tracy L. McCuan, Chief System Engineer of Kerrvil a Public Utility ,far and on behalf of said
Kerrville Public Utility Board.
:g'""r'"~;. CENDI L. TINININ
rar ooiwr tsarpa
=~ March 16, 2006
2 Typed or pri/nted ~ e
J -~~'~~/
Notary commission expires:
ACKNOWLEDGMENT
THE STATE OF TEXAS
COUNTY OF KERB
1
This instrument was acknowledged before me this aT'1; day of `11 ~ ~;~ Y;d ~ 20;1,x, by
Kenneth Bledsoe and Jennifer Bledsoe.
+Y,~•^~'; i~P1DRA MICHl1LE WAY
~a~~ OCTOBER 10,2007
OCT 0 3 2~Q5
of ry ublic, State of Texas
,
~!2 l ~~ l//9~'I/
~~ ~ n Ir
Notary Public, State of exas
~~ a (u ~Lt~~;i ~;
yped or pr ter~name
Notary commission expires:
T r~~x ± °~
EXHIBIT °a°
PROPERTY: All that certain tract or parcel of land, lying and being situated in the County of Kerr, State
of Texas and being Lots 14 and 15 Cedar Ridge Subdivision, a subdivision of Kerr County, Texas,
according to the plat of said subdivision recorded in Volume 4, Page 4, Plat Records of Kerr County
Texas.

.__r_::~
. ocr o 3 Zoos

CONSENT TO ENCROACHMENT ~~' ° ~ cuu~
~ J
THE STATE OF TEXAS § %"t"1"'?t c
§ KNOW ALL MEN BY THESE PRESENTS:. '
COUNTY OF KERR § ~ ~~_` __
That by instrument recorded in Volume 4, Page 4, of the Plat Records of Kerr County, Texas, a certain easement
and easement rights more particularly described in Exhibit A, attached hereto and made a part hereof for all
purposes (collectively the "Easement")were created, reserved or granted in favor of [he Time W arner Cable being
the undersigned owner and beneficiary thereof ("Owner", whether one or more) across the property which is more
particularly described in Exhibit A (the "Property").
NOW, THEREFORE, Owner, have [his day and do by these presents CONSENTS:
A. To the existing building encroachment into Easement as reflected on the survey plat attached
hereto and made a part hereof for all purposed as Exhibit B; and,
B. To the maintenance, repair and reconsVuction of any such improvements; PROVIDED,
HOWEVER, that any such reconstruction of improvements shall not result in an expansion of said
existing encroachments or in any additional encroachments within the Easement; and PROVIDED
FURTHER, that if any improvements existing within the Easement at the time of execution of this
Consent to Encroachment are des Voyed, demolished, or otherwise removed from the property such
that the existing encroachment is abated, reconstruction of any improvements shall not encroach
into the Easement.
In consideration of the consent granted above by Time Warner Cable, the undersigned KENNETH BLEDSOE
AND JENNIFER BLEDSOE, for themselves and their successors in title to the Property, agrees, to release,
indemnify, and hold harmless, TIME WARNER CABLE, ITS OFFICERS, EMPLOYEES, AGENTS AND
CONTRACTORS, from any damage to any improvements encroached within the easement as the result of the
installation, maintenance, repair, or replacement by TIME WARNER CABLE, ITS OFFICERS, EMPLOYEES,
AGENTS AND CONTRACTORS, of any utility facilities, located or to be located within the Easement,
W HETHER OR NOT SUCH DAMAGE IS THE RESULT OF THE NEGLIGENT ACT OR OMIS SION OF TIM E
WARNER CABLE, ITS OFFICERS, EMPLOYEES, AGENTS OR CONTRACTORS.
EXECUTED THIS ~~ DAY OF _~ ~~~ , 2005
Time Warner Cable:
X By: ~t. ~sw~i,~ ~
~ Name: /~9`~ BVR?Olf/
~ Title: T ~hN~ «IZ_ Su~v~.r~z
Property Owners:
By: lw ~,
Kenneth Bledsoe
Jennifer Bledsne
EXHIBIT "A^ OCT 0 3 2005
~,~,; k
PROPERTY: All that certain tract or parcel of land, lying and being situated in~he'Colmtq of K~rr, State
of Texas and being Lots 14 and 15 Cedar Ridge Subdivision, a subdivision of Karr County, Texas,
according to the plat of said subdivision recorded in Volume 4, Page 4, Plat Records of Kerr County
Texas.
- - ~.n ,-'y Renl P,npr,ly Re<mds
~~ ~ ^'; DP~a UI ilusl kw o~ds
,. ,. ' 'u~.; 'nm,l ~" 4rles k Bound,
_...,, i ly-,uinR unq/a, Q,[tt)p, ,. roll u,

SURVEY PLAT OF LOT 16, CEDAR RIDGE, A SUBDIVISION OF
KERR COUNTY, TEXAS, RECORDED IN VOLUME 4, PAGE 4,
PLAT RECORDS OF KERR COUNTY, TEXAS.
1\
S 06°55' / !0140'
52"E 1O1.5T' __---- -~
....y, `- Inn I/>" non p,ft ~
- __ III UL W~'\.------~1 -
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11 B' FROM
U.E.
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PAD UES UP TO 2 d' FROM
PROPERTY UNE. --- ---
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PROPOSED 1 ~; N.,, 4
RESIDENCE
0.50
~ - - ~, trr.nt - -- ,
----;
`----Idn wa uu 6:v~
N. W ~,
ALVIN DRIVE
50 FT WD R.O. W.
-~=- - _
\ N 04'32'96' W 102 23'
~,au. r.w TNt !~.c .~~
RECORD BEARING BASIS HELD
N 04.39'00' W BETWEEN SURVEY
MONUMENTS FOUND AT THE SW
CORNER OF l0T 14 AND THE NW
CORNER OF LOT 16
.~~ m 1! ~ , ,: ,
~ /
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OCT 0 3 2 5
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CONSENT TO ENCROACHMENT OCT 0 3 2005
THE STATE OF TEXAS § _
§ KNOW ALL MEN BY THESE PRESENTSi~~~ 3 )°
COUNTY OF KERB §
4ti~'
That by instrument recorded in Volume 4, Page 4, of the Plat Repords of Ketr County, Texas, a certain easement
and easement rights more particularly described in Exhibit ,attached hereto and made a part hereof for all
purposes (collectively the "Easement") were created, reserved or granted in favor of the Kerrville Telephone
Company being the undersigned owner and beneficiary thereof ("Owner", whether one or more) across the
property which is more particularly described in Exhibit A (the "Property").
NOW, THEREFORE, Owner, have this day and do by these presents CONSENTS:
A. To the existing building encroachment into Easement as reflected on the survey plat attached
hereto and made a part hereof for all purposed as Exhibit B; and,
B. To the maintenance, repair and reconstruction of any such improvements; PROVIDED,
HOWEVER, that any such reconstruction of improvements shall not result in an expansion ofsaid
existing encroachments or in any additional encroachments within the Easement; and PROVIDED
FURTHER, that if any improvements existing within Che Easement at thetime of execution of this
Consent to Encroachment are destroyed, demolished, or otherwise removed from the property such
that the existing encroachment is abated, reconstruction of any improvements shall not encroach
into the Easement.
In consideration of the consent granted above by Kemille Telephone Company, the undersigned KENNETH
BLEDSOE AND JENNIFER BLEDSOE, for themselves and their successors in title to the Property, agrees, to
release, indemnify, and hold harmless, KERRVILLE TELEPHONE COMPANY, ITS OFFICERS, EMPLOYEES,
AGENTS AND CONTRACTORS, from any damage to any improvements encroached within. the easement as the
result of the installation, maintenance, repair, or replacement by KERRVILLE TELEPHONE COMPANY, ITS
OFFICERS, EMPLOYEES, AGENTS AND CONTRACTORS, of any utility facilities, located or to be located
within the Easement, WHETHER ORNOT SUCH DAMAGE IS THE RESULT OF THE NEGLIGENT ACTOR
OMISSION OF KERRVILLE TELEPHONE COMPANY, ITS OFFICERS, EMPLOYEES, AGENTS OR
CONTRACTORS. ~,, ~J y~
EXECUTED THIS U/t-"DAY OF oCI~~'-ivt__ , 2005
Kerrville Telephone Company:
~fI
Name: Charles H. ~Ctu1z
al Ma
Owners:
By: i
Kenneth Bledsoe
Jennifer Bledsoe
ACKNOWLEDGMENT
THE STATE OF TEXAS
COUNTY OF KERB
ocr o ,~ zany
-..~
-~--•~ ,a
w
Thisinstrumentwasacknowledgedbeforemethis Rio }~ day of StIOTEMiSC-~t.
2005, by (Name & Title l ~. kMd! LES it. K~' N z ~ G-e ~t ~~rr wr,rnJAC-c`>Z-
of Kerrville Telephone Company, for and on behalf of said Kerrville Telephone Company.
~a JAMES D. RIIEY
e"off" .4g`t
~' ~:' Nota Public, Stale ol7exas
~_ ry
^~r' < MY Ca^mission F~irBB
°,•r~o;+t*~•' SEPT. 29, 2009
~..~'
THE STATE OF TEXAS §
cs~..~-.o ~ .
Notary Public ate of Texas
~~ ft~~5 b . 12tcr~t
Typed or printed name
ACKNOWLEDGMENT
v i/a~~ay
Notary commission expires
COUNTY OF KERR §
"this instrument was acknowledged before me this OlY/l day of O~i"~'..~/C~
2005, by Kenneth Bledsoe and Jennifer Bledsoe

.if-rI
' •••' ~•~	B.E.VERHELST


.
y
.
.	Notary PuWb, Stem of Texea
My Canmicabn Expiry
•
,
.~~	JANUARYZg,2006
~~/.~--
Notary,, P//ublic, State of Texas
~i~~~ ~ - y~~'T
Typed or printed name
Notary commission expires
ACT 0 3 2005
EXHIBIT "A"
~ - J
,-~_.
PROPERTY: All that certain tract or parcel of land, lying and being situated in the County of Kerr, State
of Texas and being Lots 14 and t 5 Cedar Ridge Subdivision, a subdivision of Kerr County, Texas,
according to the plat of said subdivision recorded in Volume 4, Page 4, Plat Records of Kerr County
Texas.
- - ~-rr ..,;:'y Renl Properly Records
. .. .ray Dertl 01 liutl Rrrords
~„ ~ ' ~ti~d "nmq in ~APIPS g (j9rrnd~
-.~ nd I:~~nr~nq und~ai Or4lpmr roll rn
.. ~~~e„~ 1-'~~I, r^r nrlyd plul rl~
"1
,
..
11 8' FROM
U.E.
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h
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~n.~,
„w a wm,
ALVIN DRIVE
50 FT WD R.O.W.
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O.H[- µ. ~~t S.t-Kc
0
0
N
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r
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O
RECORD BEARING BASIS HELD
N 04'33'00' W BETWEEN SURVEY
MONUMENTS FOUND AT THE SW
CORNER OF LOT 14 AND THE NW
~' CORNER OF LOT 15
~ ~ ' ~~ ~ , r . a r ', ,,,.;, ,
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~ In .in.y,r IL. ~,~rA
,
y Q; !R7!(' ( 101 ?0' uu
S06°55'S2"E 101.57 i
____ III UL IY'~~__---~1
a~l PAD LIES UP TO 2.4' FROM "~ ~~
~yl~l PROPERTY LINE. -- ~ - --..° ~\ 1,,
111 - 111 ',
.--
`11 ', PAD - _. q9' 1
._ c? it~~'' 2 ~ PROPOSED l
.'. ~ ,\ ~, ~~ N RESIDENCE
1N ' N 1 ~
W ~ ~, TPpN i
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t-. N ~ .. _ ::...
1 - 4.6' FROM
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Iy' E
~: 7

SURVEY PLAT OF LOT 16, CEDAR RIDGE, A SUBDIVISION OF
KERR COUNTY, TEXAS, RECORDED IN VOLUME 4, PAGE 4,
PUT RECORDS OF KERR COUNTY, TEXAS.
0.50
S 06_'54'01' E 101 11 _
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04 I02.3'l~~ ~ N 04'32'36" W 102 23' _ _ -
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Revised ]O-OS-OS
one extra for the Clerk to ensure, that one rs ut into the record.
,~ ~L~~ ~(ti_ .
Name: %~~~1 J~~ g `*~Y~
Address: ~~ ~~ ~~~(~ ~'~.S
~(~~
i
~/~
PUBLIC PARTICIPATION FORM
FOR
KERB COUNTY COMMISSIONERS' COURT
Instructions: Fill out all appropriate blanks. Please print or write legibly. Present to the County
Clerk prior to the time that the Agenda Item (or Items) you wish to address are discussed. If
you are handing out any material or documents to the Court, please make sure you have
Telephone: ~ ~ L> ~) ~ ~' ~~ ~/
Place of Employment: ~cosoE L~N'~uE,t~A (i L~~(ftRetl/~`~ 1 ~C
Employment Telephone: ~'3c~ ~~~- ~A~~~~
Do you represent any particular group or organization? Yes ~ No ~"~
If you represent a group or organization, please state the name, address and telephone number of
such group or organization.
Which agenda Item (or Items) do you wish to address?
In general, are you for or against such Agenda Item (or Items)? For Against
0
Signature
NOTE: This Public Participation Form must be presented to the County Clerk prior to the
time the agenda item(s) are discussed.
Once you reach the podium. please state your name and who/what You
represent clearly for the court reaorter to accurately record who you are.