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voQUP COL'.Vp� ''c <br /> y <br /> Loudoun County Health Department <br /> P.O. Box 7000 <br /> 1757 Leesburg VA 20177 -7000 <br /> Environmental Health Community Health <br /> Phone: 703 / 777 -0234 Phone: 703 / 777 -0236 <br /> Fax: 703 / 771 -5023 Fax: 703 / 771 -5393 <br /> All grantors of record of the Property must sign this deed restriction <br /> Grantor (print name) M IIIIIIIII <br /> 201 <br /> Loudoun County, VA P9s: 1 <br /> 04/14/2011 2:08:05PM <br /> Grantor (print name) Gary M. Clemens , Clerk <br /> do understand and agree that any structure within 100 feet of any well cannot be treated for <br /> termites or wood boring insects by spray or chemical injection per Chapter 1040 of the Loudoun <br /> County Codified Ordinances until such time as said well(s) has (have) been properly abandoned <br /> according to the State of Virginia regulations and County of Loudoun Ordinances. This <br /> restriction shall remain in force until a proper release of restriction has been granted by the <br /> Loudoun County Health Department and duly recorded in the land records for the property. <br /> Grantor <br /> Grantor <br /> State of Virginia, County of Loudoun <br /> Date � <br /> The foregoing signature(s) were acknowledged before me this day of a A J , <br /> by K�� t� (,( Grantor, and Grantor <br /> My Commission expires 66 /'q* # <br /> Loudoun County PIN number 01 3 1 5 2 3 8 <br /> GLAIRF "''•,. <br /> Please type or print legibly all pertinent information TARY <br /> AZ <br /> asos J� <br /> VIRGINIA <br /> REG �1�IIS5 ►ON Q <br /> �>.'•. 051311 � <br /> VDHOF HEALTH <br /> orrvr <br /> M1akcft You and Yaw fnvwmm wM 1 1 1 1 ` „✓ <br />