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OWNER’S CONSENT AND DEDICATION
Know all men by these presents, that the subdivision of land as shown on this plat, containing ______ acres, or more or less and designated as ____________________ Subdivision situated in the ____________________ District of Richmond County, Virginia, is with the free consent and in accordance with the desires of the undersigned owners thereof; that all streets shown on said plat are hereby dedicated to the public use, and that all lots within the subdivision are subject to certain restrictions, reservations, stipulations and covenants as contained in a writing executed by the undersigned, under date of _______________, 20___, and recorded in the Clerk’s office of Richmond County in Deed Book ______, Page ______. The said ______ acres of land hereby subdivided having been conveyed to ____________________ by ____________________ by deed dated _______________, 20___, and recorded in the Clerk’s office of the Circuit Court of Richmond County, Virginia, in Deed Book ______, Page ______.
Given under our hands this ______ day of _______________, 20___.
I hereby certify that to the best of my knowledge and belief, all of the requirements of the Board of Supervisors and ordinances of Richmond County, Virginia regarding the platting of subdivisions within the County have been complied with.
Given under my hand this ______ day of _______________, 20___.
State Certified Engineer (or Land Surveyor)
CERTIFICATE OF APPROVAL
This subdivision known as ________________________ Subdivision is approved by the undersigned in accordance with existing subdivision regulations and may be committed to record.
Date Highway Engineer
Date Health Officer
Date Agent or Representative of the Governing