EDITOR'S NOTE: Appendix is available in PDF, click HERE
SECTION I. Required Statements to be Affixed on the Subdivision
Plat:
OWNER'S ACCEPTANCE AND DEDICATION
I/We, the undersigned owner(s) of the land(s) shown on the within plat, hereby acknowledge the making of said plat to be my/our free act and deed, and do hereby accept said plat and dedicate the streets and other public areas as shown to public use forever. In witness whereof, I/we have set my/our hands and seals this day of , 20 .
Owner(s) Witness(es)
STATE OF OHIO, COUNTY OF RICHLAND, VILLAGE OF BELLVILLE: S.S.
Before me a notary public is and for said county and state, personally appeared the above owner(s) who then and there acknowledge the making and signing of the within plat to be his/her/their free act and deed and for the uses and purposes shown thereon in testimony, whereof I have hereunto set my hand and official seal this day of , 20 ;
Notary Public
Richland County, Ohio
My Commission Expires
SECTION II. Required Signatures:
Certificate of Surveyor
I hereby certify this plat represents a survey made by me, that all notes, dimensions and geodetic details are correct, that the survey closes with an error of one foot in 25,000 feet or less and that the monuments shown exist or shall be set as shown.
Date
Name
Surveyor No.
Village Engineer Approval
I hereby approve the above plat and dedication. No acceptance of the dedicated streets upon the public road system is meant or implied.
Date
Name
Village Engineer
Richland County District Board of Health
(Applicable for Wells and Septic Systems)
I hereby approve the within plat and dedication.
Date
Name
Richland County District Board of Health
Village of Bellville Planning Commission
I hereby certify that the within plat and dedication were duly approved by the Village of Bellville Planning Commission for Richland County, Ohio, at its regular meeting held on the day
of , 20 .
Date
Name
Chairperson
Village Council
I hereby certify that the within plat and dedication were duly approved by the Bellville Village Council at its regular meeting on the day of , 20 .
Date
Mayor
County Auditor
I hereby certify that there are no delinquent taxes or delinquent special assessments against
herein described and these platted lands were transferred on the day of , 20 .
Date
Richland County Auditor
County Recorder
Filed for record this day of , 20 , at (time).
Recorded this day of , 20 in Plat Volume , Page .
Date
Richland County Recorder
Performance Guarantees – Amount
I hereby certify that a performance guarantee in the amount of for the construction of required improvements for the land contained in this plat have been provided and approved as to amount.
Date
Village Engineer
Performance Guarantees – Form
I hereby certify that a performance guarantee in the amount of for the construction of required improvements for the land contained in this plat have been provided and approved as to amount.
Date
Village Solicitor