APPENDIX I: FORMS FOR FINAL PLAT CERTIFICATION
   Form 1
   (On Plat)
   CERTIFICATE OF OWNERSHIP AND DEDICATION
   WATER AND SEWAGE SYSTEM
   CERTIFICATION OF ACKNOWLEDGEMENT NOT APPROVED BY HEALTH        DEPARTMENT PLEASE READ BELOW CERTIFICATE
(The above statement is required to be in bold type, underlined and at least 1/4" tall)
I/We hereby certify that I/we am/are the owner’s of the property shown and described hereon and that I hereby adopt this plan of subdivision with my free consent, establish the minimum building restriction lines, and dedicate all streets, alleys, walks, parks and other open spaces to public or private use as noted. I/we understand that the approval of this plat shall not be deemed to constitute an acceptance by the McCracken Fiscal Court that the lots in this subdivision are suitable for a private sewage disposal system. The owner or developer of any lot, or lots, must meet the minimum requirements and obtain the necessary approvals for the use of a private sewage disposal system from the Department of Housing, Buildings and Construction, Division of Plumbing, Commonwealth of Kentucky, or any successor governmental agencies.
I hereby certify that I have read and understand the foregoing notice.
Owner                               Date:                        Owner                       Date:                                      
Owner                               Date:                        Owner                       Date:                                      
   State of Kentucky
   SS
   County of McCracken
I,                                      , a notary public in and for the State & County aforesaid, do hereby certify that the foregoing plat of survey was this day presented to me by                  , known to me, together with the Certificate of Ownership and Dedication shown hereon, which was, executed in my presence and acknowledged to be their free act and deed.
Witness my hand and seal this              day of                                                 ,               
My Commission expires on the        day of                                                 ,               
   Notary Public
Form 2
   (on plat)
CERTIFICATE OF ACCURACY
I hereby certify that the plan shown and described hereon is to the best of my knowledge and belief to be true and correct survey to the accuracy required by the McCracken County, Kentucky, Planning Commission and that the monuments have been placed as shown hereon, all in accordance with the minimum standards of practice as promulgated by the Kentucky Revised Statute and the Kentucky Administrative Regulations.
Date:                                             
Professional Land Surveyor:                                             
   Form 3
   (on plat)
   CERTIFICATE OF FINAL APPROVAL FOR RECORDING
I hereby certify that the subdivision plat shown here on was given final approval by the McCracken County Fiscal Court.
Date
Judge Executive or designee
   Form 4
   (on plat)
   CERTIFICATE OF FINAL APPROVAL FOR RECORDING
I hereby certify that the subdivision plat shown herein has been found to comply with the Subdivision Regulations for McCracken County, Kentucky, with the exception of such variances if any, as are noted in the minutes of the Planning Commission and that the subdivision plat was given final approval by the McCracken County Planning Commission.
Planning Commission meeting held                                             
McCracken County Planning Commission Chair
   Form 5
   (on plat)
   CERTIFICATE OF FINAL APPROVAL FOR RECORDING
I hereby certify that the Corporate Surety, Cash or Equivalent has been posted and approved by McCracken County Fiscal Court; in the amount sufficient to assure such completion of all required improvements.
Date:                                             , 20       
Judge Executive or Designee McCracken County, Kentucky
   Form 6
   (on plat)
   CERTIFICATE OF RECORDING
   “State of Kentucky, County of McCracken”
I,                                             , Clerk for the county and state aforesaid do hereby certify that this plat was this day lodged in my office for record and that I have recorded same with this and the foregoing certificate in my office.
Given under my hand and seal this the                                                day of   , 20       
By                                             D.C.                                              Clerk
Recorded in plat section                                             page                                            
   Form 7
   (on plat)
I hereby certify that the subdivision plat shown hereon substantially complies with McCracken County regulations and policies as required.
Date                                             Judge Executive or Designee                                             
(Ord. passed 11-27-2017)