APPENDICES
A. Forms
for Final Plat Certification
The following forms shall be affixed on
the original plat if applicable:
Form 1. CERTIFICATE
OF OWNERSHIP AND DEDICATION
I (we) hereby certify
that I am (we are) the owner (s) of the property shown and described hereon and
that I (we) hereby adopt this plan of subdivision with my (our) free consent,
establish the minimum building restriction lines, and dedicate all roads,
alleys and walks to public use; and dedicate all parks and other open spaces to
public or private use as noted.
_________________________,
_____ ______________________________
Owner
_________________________ ______________________________
Date Owner
Form 2. CERTIFICATE
OF ACCURACY
I hereby certify that
the plan shown and described hereon is a true and correct survey to the
accuracy required by the Oak Ridge Subdivision Regulations and that the
monuments have been placed as shown hereon, to the specifications of the said
Regulations.
_________________________,
_____ ______________________________
Registered
Surveyor
_________________________ ______________________________
Date State in which registered
______________________________
Registration Number
Form 3. CERTIFICATION
OF THE APPROVAL OF WATER AND SEWAGE SYSTEMS
I hereby certify that
the water supply and sewage disposal utility system installed, or proposed for
installation, fully meets the requirements of the Tennessee Department of
Environment and Conservation and locally established standards, and are hereby
approved as shown.
_____________________________,_____
Date
____________________________________________________
Health Officer designated by the Planning Commission
Form 4 CERTIFICATION OF THE APPROVAL OF
UTILITIES AND REQUIRED IMPROVEMENTS
I hereby certify that:
(1)_______ All required improvements have been completed satisfactorily,
or (2)_______ No required improvements are included in this project,
or (3)_______ A security bond in the amount of $___________ has been posted to assure completion of all required improvements in case of default.
___________________________________________ ________________
Approving Agent Designated by the Date
Planning Commission
Form 5. CERTIFICATE
OF APPROVAL FOR RECORDING
I hereby certify that
the subdivision plat shown hereon has been found to comply with the Subdivision
Regulations for the Oak Ridge, Tennessee Planning Region, with the exception of
such variances, if any, as are noted in the minutes of the Planning Commission
and that it has been approved for recording in the office of the County
Register.
____________________________,
_____
Date
______________________________
Secretary,
Planning Commission
Form
6. CERTIFICATION OF THE APPROVAL OF
PRIVATE SEWAGE DISPOSAL SYSTEM
I hereby certify that the private sewage disposal system installed, or proposed for installation, fully meets the requirements of the Tennessee Department of Environment and Conservation and locally established standards, and is hereby approved as shown.
_______________________, ______
Date
__________________________________
Approving Agent designated
by TDEC
__________________________________