Name: Phone:

Firm: Fax:

Type of Services:

☐Title Survey

☐Alta Land Title Survey

☐Boundary Survey

☐Topographic Survey

☐Aerial Control Survey

☐Construction Stake-Out

☐Utility Survey

☐Wetland Location Survey

☐Subdivision Services

☐Flood Elevation Cert.

☐FAA- 1A or 2A Cert.

☐Monitoring Well Survey

Work Details:

Buyer’s Name:

Lender’s Name:

Title Co. Name:

Corner Markers: ☐ Set Corners ☐ Do Not Set Corners

This is to advise that we have been made aware of our right to have corner markers set as part of a survey to be performed on the above referenced property. That right is hereby waived and you are directed to perform the land survey without the setting of corner markers as provided by the regulation of the New Jersey Board of Professional Engineers and Land Surveyors.

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Date	Signature