Gis Map Request Form - Northumberland County (Page 2 of 2) in pdf

Gis Map Request Form - Northumberland County Page 2

The County of Northumberland, its employees, and agents shall not be liable for, and the user hereby waives, any claims for

damages or loss arising directly or indirectly from the use, application or interpretation, of the information and maps provided by

any party.

Do not rely on this map for legal administrative purposes or applications that require accurate positional data. Do not rely on it as

being a precise indicator of routes, locations of features, or as a guide to navigation. The user acknowledges that these maps may

contain cartographic errors or omissions.

________________________________________

__________________________________________

Signed in agreement of this waiver

Print name

________________

Date

For Office Use Only

Date Received:

Date Completed:

Days to Complete:

Type of Request:

Custom Map

Other __________________________________________________________

Received by:

Mail

Telephone

Fax

Number of Layers

included in Map:

Number of Copies:

Notes:

Request for payment sent?

Y Yes

Payment Received:

Yes

How much received:_________

All correspondence attached?

Yes

Request Completed?

Yes

Request completed by: ____________________________________

Date:____________________

Gis Map Request Form - Northumberland County Page 2