1224.05   STATEMENTS AND SIGNATURES REQUIRED ON FINAL MAP.
   It is recommended that the final map contain the applicable forms and wording as follows:
   (a)   Description.
   Situated in the State of Ohio, County of Clark (Miami), Municipality of New Carlisle (Township shall be designated here for three-mile area plats) and being a part of Section       Town          , Range         M.R.S. and being further described T-ts-Thllows: Being a subdivisiot-Ta— acres and being all the land contained within the boundaries shown as A, B, C, D, E, F, G, H, I and   , being part of the land conveyed to          
by deed from        dated       and recorded in Vol.           page       , in the deed records of Clark (Miami) County, Ohio. Also being all the land conveyed to       by deed from        dated        and recorded in the deed records of Clark (Miami) County, Ohio, in Vol.   and page.
   (b)   Owner's Dedication and Acknowledgment.
   We, the undersigned, being all the owners and lien holders of the land platted herein, do hereby voluntarily consent to the execution of such plat, and dedicate the streets as shown hereon, comprising a total of     acres, to the public use forever.
   Easements shown on this plat are for the construction, operation, maintenance, repair, replacement or removal of water, sewer, gas, electric, telephone or other utility lines or service, and for the express privilege of removing any and all trees or other obstructions to the free use of such utilities and for providing ingress and egress to the property for such purposes and are to be maintained as such forever.
   Vehicular right of access shall not be allowed across the ten-foot easement lying parallel to     Street, along the rear of lots    ,    ,     and    , except as stipulated in the preceding paragraph. (This type of easement shall be used when lots back onto major vehicular trafic arteries.)
   This plat is subject to the convenants and restriction shown on the separate document attached hereto and labeled “sheet 2 of 2 pages”. (This item is applicable only if the restrictions are listed on a second sheet.)
   (c)   Approval by Planning Authority.
   I hereby certify that this plat was approved by the Commission on     and the City Planning Board of New Carlisle, Ohio, on     This approval becomes void unless this plat is filed for recording within 180 days of this approval. Certified                  .
                  
   Secretary, New Carlisle Planning Board
   (d)   Certification by Health Official (when applicable).
   I hereby certify that this plat meets the requirements of the County Health Department.
                              ________________________________
                                 Director, Clark (Miami) County
                                 Board of Health
(This signature is not required if community sewer and water facilities are made to the new lots.)
   (e)   County Auditor.
   I hereby certify that the land described by this plat was transferred on    ____________________.
                              ________________________________
                                 Clark (Miami) County Auditor
   (f)   County Recorder.
   I hereby certify that this plat was filed for recording on ____________________, and that it was recorded on _______, in Vol. _______, page , _____________ plat records of Clark (Miami) County, Ohio.
   Fee $ _______________
      _______________________________
      Clark (Miami) County Recorder
   (g)   Certification by Surveyor.
   I hereby certify that this plat represents a true and complete survey made by my supervision in 19___ , and that all markers are correctly shown as to material and location.
      _______________________________
      Registered Surveyor
   (h)   Certification by the Director of Public Service.
   I hereby certify that a copy of this plat was filed in the Municipal Engineer's office.
      Date ______________________          By ______________________________
                                 Director of Public Service
   (i)   Acknowledgment by City Manager.
   I hereby acknowledge that adequate improvement assurances have been made.
      Date ____________________          By ______________________________
                                 City Manager
(Applicable only if Municipality is the payee of a certified check or a party to a bond agreement.)