It is required that the Phase 2 plat contain the applicable forms and wording as listed below.  These statements and signatures (as well as covenants and restrictions) may be required to be affixed on separate sheets.
   (a)   Description.
Situated in the State of Ohio, County of Clark, City of Springfield, (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 as follows:  Being a subdivision of _____ acres and being all the land contained within the boundaries shown as A, B, C, D, E, F, G, H, I, and J, and being part of the land conveyed to _____ by deed from _____, dated _____ and recorded in Volume _____, page _____, deed records of Clark County, Ohio.  Also being all the land conveyed to _____, by deed from _____, dated _____ and recorded in deed records of Clark County, Ohio, Volume _____, and page _____.
   (b)   Owners' Dedication.
We, the undersigned, being all the owners and lienholders of the land platted herein, do hereby voluntarily consent to the execution of said plat and dedicate the streets as shown hereon, comprising a total of _____ acres, to the public use forever.
Easements shall be of such size and width as shown on the plat map and are for the construction, operation, maintenance, repair, replacement, or removal of water, gas, sewer, 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 said utilities and for providing ingress and egress to the property for said purposes and are to be maintained as such forever.
   (c)   The following language shall be used when lots back onto major vehicular traffic arteries:
Vehicular right-of-access shall not be allowed across the right-of-way line of _____ Street, along the rear of lots _____, _____, _____, and _____, and such right-of-vehicular access is hereby relinquished and released to the City of Springfield, Ohio, (or other political subdivision having control of said street).
   (d)   The following language shall be used only if the restrictions are listed on a second sheet:
This plat is subject to the covenants and restrictions shown on the separate document attached hereto and labeled "Sheet 2 of 2 pages".
   (e)   Acknowledgment.
State of Ohio
County of Clark
Be it remembered that on this ____ day of _____, _____, personally came the said John and Jane Doe, to be known and acknowledge the signing and execution of the foregoing statement to be their voluntary act and deed.
Notary Public, State of Ohio
   (f)   Approval of Planning Commission.
I hereby certify that this plat was approved by the [City Planning Board of Springfield, Ohio, or CEDA Planning Commission, as applicable] on _____.  This approval becomes void unless this plat is filed for recording within one calendar year of this approval.
Certified ________________________________
Secretary, [City Planning Board of Springfield, Ohio, or CEDA Planning Commission, as applicable]
   (g)   Certification by Health Official, When Applicable
I hereby certify that this plat meets the requirements of the Clark County Combined Health District.
Health Commissioner, Clark County Combined Health District
   (h)   County Auditor.
I hereby certify that the land described by this plat was transferred on _____.
Clark County Auditor
   (i)   County Recorder.
I hereby certify that this plat was filed for recording on _____, and that it was recorded on _____, in Volume ____, Page _____, plat records of Clark County, Ohio.
Fee $________________
Clark County Recorder
   (j)   Certification of Surveyor.
I hereby certify that this plat represents a true and complete survey made by me or under my supervision in _____, and that except as otherwise stated upon the map, all monuments shown thereon actually exist.
Registered Surveyor No. _____
   (k)   Certification by the City Engineer.
I hereby certify that a copy of this plat was filed in the Service Department and that it has been approved by the City Engineer in accordance with the Ohio Rev. Code 711.08.
        City Engineer
(Ord. 20-100.  Passed 4-7-2020.)
   (l)   Statement of Acceptance.
Dedication of the land shown on this plat for roads, streets, or other public purposes is hereby accepted as of _____, by The City of Springfield, Ohio.
Date  ___________________________________
By:  ____________________________________
   City Manager
   (m)   Acknowledgment of City Manager.
(Applicable only if City is the payee of a certified check or a party to a bond agreement.)
I hereby acknowledge that adequate improvement assurances have been made.
Date  ___________________________________
By:  ____________________________________
   City Manager
(Ord. 19-289.  Passed 12-10-19.)