APPENDIX E: CERTIFICATES AND APPROVALS
Note: To view Appendix E forms in PDF, please click FORMS
OWNER’S CERTIFICATE:
STATE OF ILLINOIS   )
               ) SS
COUNTY OF LAKE   )
This is to certify that the undersigned is/are the sole owner(s) of the land described in the annexed plat herein, that no other person has any right, title, or interest in said land and that he/she/they has/have caused the same to be surveyed and subdivided as indicated thereon for the uses and purposes therein set forth, and does hereby acknowledge and adopt the same under the title thereon indicated.
Dated at                                   , Illinois, this                                   day of                                   , A.D. 20      .
                                 
Owners
STATE OF ILLINOIS   )
               ) SS
COUNTY OF LAKE   )
I,                                   , a Notary Public in and for said county, in the State aforesaid, do hereby certify that                                   , personally known to me to be the same person(s) whose name(s) is/are subscribed to the foregoing instrument as such owner(s), appeared before me this day in person and acknowledged that he/she/they signed and delivered the annexed plat as his/her/their own free and voluntary act for the uses and purposes therein set forth.
Given under my hand and notarial seal, this             day of                                   , A.D., 20    at                                   , Illinois.
(SEAL)
                                 
Notary Public
SURVEYOR’S CERTIFICATE:
STATE OF ILLINOIS   )
               ) SS
COUNTY OF LAKE   )
This is to certify that I,                                   , a Registered Illinois Land Surveyor, No.                                   , have surveyed and subdivided the property as described and shown by the annexed plat, which is a correct representation of said survey and subdivision. All distances are shown in feet and decimals thereof. All lots meet the requirements of the Lake County Unified Development Ordinance in regard to lot area, width, and buildable area.
Further, I certify this subdivision is (is not) situated within five hundred (500) feet of a surface drain or water course serving a tributary area of 640 acres or more.
The above described tract is/is not located within the area designated as a flood hazard as shown in the flood insurance rate map Community Panel No.                                  , dated                                   as published by the Federal Emergency Management Agency.
This is also to certify that the Village of                                   is within 1-1/2 miles of the proposed subdivision.
Given under my hand and seal at                                   , Illinois, this                 day of                 , A.D., 20      .
(SEAL)
                                                                   
Registered Illinois Land Surveyor
OWNER’S SCHOOL DISTRICT CERTIFICATE:
This is to certify that I                                   as owner of the property described as the                                                         Subdivision and legally described on the plat of the same name, have determined to the best of my knowledge the school district in which each of the following lots lay.
Signature of Owner
      LOT NUMBER(S)               SCHOOL DISTRICTS
                              ELEMENTARY HIGH SCHOOL UNIT DISTRICT
STATE OF ILLINOIS   )
               ) SS
COUNTY OF LAKE   )
I,                                  , a Notary Public in and for said county, in the State aforesaid, do hereby certify that                                   , owner of the property commonly known as                                  Subdivision, appeared before me this day in person and acknowledged the execution of this statement as his free and voluntary act.
Given under my hand and notarial seal, this                         day of                                   A.D., 20    at
                                  , Illinois.
(SEAL)
                                 
LAKE COUNTY CLERK’S CERTIFICATE:
STATE OF ILLINOIS   )
               ) SS
COUNTY OF LAKE   )
I,                                 , County Clerk of Lake County, Illinois, do hereby certify that there are no delinquent general taxes and no redeemable tax sales against any of the land included in the annexed plat. I further certify that I have received all statutory fees in connection with the annexed plat.
Given under my hand and seal of the County Clerk at Waukegan, Illinois this               day of                 , A.D. 20      .
(SEAL)
                                 
County Clerk
CERTIFICATE OF THE COUNTY ENGINEER:
STATE OF ILLINOIS   )
               ) SS
COUNTY OF LAKE   )
I,                                   , County Engineer of said County, do hereby certify that the annexed plat has been examined by me and found to comply with the highway requirements as set forth in the regulations governing plats of subdivided lands adopted by the County Board of Lake County, Illinois.
Dated this                 day of                        , A.D. 20_____ at                                  .
                                 
County Engineer
CERTIFICATE OF HIGHWAY ACCESS AUTHORITY:
STATE OF ILLINOIS   )
               ) SS
COUNTY OF LAKE   )
This plat is hereby approved this           day of                       , A.D. 20      by the County Engineer of Lake County pursuant to Chapter 765, Act 205, Section 2 of the Illinois Compiled Statutes, as amended, as to roadway access to County Highway               also known as                               . Direct access either to or from County Highway             shall be restricted as shown on this plat and shall be subject to the Lake County Highway Access Regulation Ordinance which requires, in part, that application be made and an access permit be obtained from the County Engineer of Lake County prior to any access installation.
                                 
County Engineer
PLANNING BUILDING AND ZONING COMMITTEE CERTIFICATE:
STATE OF ILLINOIS   )
               ) SS
COUNTY OF LAKE   )
Approved this           day of                                   A.D. 20      .
                                 
Lake County Plat Committee
Chair
CERTIFICATE OF TOWNSHIP HIGHWAY COMMISSIONER:
STATE OF ILLINOIS   )
               ) SS
COUNTY OF LAKE    )
I,                                   , Highway Commissioner of the Town of                                   , do hereby certify
that all matters pertaining to the highway requirements, as prescribed in the regulations governing plats adopted by the County Board of Lake County, have been complied with.
Dated this           day of                                   , A.D. 20    .
                                 
Highway Commissioner
CERTIFICATE OF THE REGIONAL SUPERINTENDENT OF SCHOOLS:
STATE OF ILLINOIS   )
               ) SS
COUNTY OF LAKE   )
I,                                   , Regional Superintendent of Schools, Lake County, Illinois, do hereby certify that all agreements and requirements required by § 151.220 of the Unified Development Ordinance of Lake County, Illinois have been reached and met by the developer. I have on file the terms of all such agreements or conditions by which the requirements of § 151.220 have been met. Agreements to contribute cash are attached and recorded together with the subject plat as document number                                   .
Dated this                     day of                                   , A.D. 20    .
                                                       
Regional Superintendent of Schools
CERTIFICATE OF THE HEALTH OFFICER:
STATE OF ILLINOIS   )
               ) SS
COUNTY OF LAKE   )
I,                                   , Health Officer of said County, do hereby certify that the plat has been examined
by me and found to comply with Lake County Board of Health Individual Sewage Disposal System Ordinance of the County of Lake, as set forth in the regulations governing plats of subdivided land adopted by the County Board of Lake County, Illinois.
Dated this                   day of                                   , 20    .
                                                     
Health Officer of Lake County
CERTIFICATE OF MUNICIPALITY:
STATE OF ILLINOIS   )
               ) SS
COUNTY OF LAKE   )
I,                                   Clerk of the (City) (Village) of                                   , do hereby certify that the annexed plat was duly approved by the (City) (Village) of                                   on the                 day of
                                  , 20    .
Dated this             day of                         , A.D. 20    .
                                 
Clerk
PLAT SUBMITTED BY CERTIFICATE:
The person listed in the following note is hereby granted permission to record this plat on behalf of
                                  , Professional Land Surveyor.
Signed:                                  
This plat submitted for recording by:
Name:                                       
Business:                                    
Address:                                    
City:                                          
State/Zip:                                    
Date:                                          
(Ord., Appendix E, passed 10-13-2009)