MINOR SUBDIVISION FINAL PLAT

Current Planning Division 410 E. 5th Street Loveland, CO 80537 (970) 962-2523 eplan-planning@cityofloveland.org www.cityofloveland.org/dc MINOR SUBDIVISION FINAL PLAT Updated 4/26/17 This application is used when land is being divided into no more than four additional lots. Any lot or tract, not including an outlot, that was created by a minor subdivision cannot be further subdivided by a subsequent minor subdivision for three years after the plat was recorded. Further subdivision within the three year period must occur through the major subdivision process. Refer to Chapter 16.20 of the Municipal Code for further information. APPLICATION CHECKLIST Applicants must submit the following information, and verify by checking the adjacent boxes, in order for the application to be accepted. All information must be submitted electronically following the specifications listed in Development Review Planning and Zoning Application Submittal Instruction Manual. Each file must be named according to the naming convention associated with each item. 1. Pre-application Meetings a. CRT (Conceptual Review Team) meeting held. Date: b. TIS Scoping meeting held. Date: 2. Filing Fee a. Complete and submit the Application Fee Worksheet, showing the fee calculation for the project: http://www.cityofloveland.org/modules/showdocument.aspx?documentid=23108. File Name: PZ# Fee Schedule.PDF b. Check made payable to the City of Loveland, submitted upon verification of the fee by the Planning office. 3. Application Checklist. File Name: PZ# Checklist.PDF 4. Application Form provided in this checklist. File Name: PZ# Application.PDF 5. Vicinity Map identifying the project site within the neighborhood context, including the nearest major cross streets, scale and North arrow. File Name: PZ# Vicinity Map.PDF 6. Final Plat prepared in compliance with the requirements in this checklist. File Name: PZ# Plat.PDF 7. Site Plan drawn to scale, including the items below (as applicable). This item is not required if a Special Review, Site Development Plan, or PUD Final Development Plan application is being processed concurrently as the site plan would be submitted with those applications. a. Existing and proposed lot lines; b. The location of all existing and proposed improvements and structures, including sidewalks, curbs and gutters, access(s), and dimensions to existing and new property lines, and an indication of any such improvements and structures that will be installed, relocated, or removed; Minor Subdivision Final Plat Checklist Page 1

c. The location and size of all existing and proposed public and private utilities, including all mains, service lines, fire hydrants, fire-sprinkler lines (if present), meters, buried cables, transformers, poles, and other above ground facilities; d. The location and size of all existing and proposed easements and rights-of-way, and an indication as to any to be dedicated, vacated, or otherwise altered; e. The location of existing and proposed landscape improvements, including existing trees, environmentally sensitive areas, wetlands, natural features and proposed bufferyards and an indication of any such landscaping that is proposed to be relocated or removed. Site Inventory - The following items are also required to be shown on the Site Plan (if present). The site area of interest for any of these items shall include adjacent lands that would affect or be affected by the proposed development. These items should be shown on the Site Plan; however if the information cannot legibly be shown on the Site Plan, an additional sheet can be prepared for the site inventory items. Staff will review the included site inventory items to determine if any additional information is needed, up to and including an Environmentally Sensitive Areas Report (ESAR) prepared by a qualified Biologist. f. Bodies of water and operating high water line for reservoirs; g. Irrigation canals and ditches; h. Jurisdictional wetlands of the U.S. and non-jurisdictional wetlands; i. FEMA Floodway and flood fringe boundaries; j. Stream corridors or estuaries; k. Land incapable of meeting percolation requirements; l. Soils having a high water table, or being highly erodible, or highly acidic; m. Land formerly used as a landfill or hazardous industrial use; n. Slopes over 20%; o. Fault areas; p. Aquifer recharge and discharge areas; q. Mature stands of vegetation; r. Wildlife habitat areas and corridors; s. Physical linkages to off-site natural areas and open spaces; t. Natural areas identified in the City of Loveland Natural Areas Inventory Study. File Name: PZ# Site Plan.PDF 8. Title Commitment verifying the record title owners and identifying encumbrances and exceptions to title. The title commitment must be dated within 30 days of the application submittal to the city. An ownership and encumbrance report does not qualify as a title commitment. Documentation for all listed Books and Pages and/or Reception numbers as cited in the title commitment must be included. File Name: PZ# Title.PDF 9. Names and Addresses of all owners of the property being subdivided, as such names and addresses appear on the latest records of the Larimer County Clerk and Recorder. File Name: PZ# Property Owners.PDF 10. Certification of Mineral Estate Owner Notification may be required if the property has associated mineral estate owners. Refer to the Mineral Estate Owners Notification Guidelines and the Mineral Estate Owners Letter and Certification. (http://www.cityofloveland.org/modules/showdocument.aspx?documentid=12317) File Name: PZ# Mineral Owners.PDF Minor Subdivision Final Plat Checklist Page 2

11. Final Public Improvement Construction Plans Checklist entitled Requirements for Public Improvements Construction Plans. (http://www.cityofloveland.org/modules/showdocument.aspx?documentid=888) File Name: PZ# PICP Checklist.PDF 12. Final Public Improvement Construction Plans complying with checklist requirements. File Name: PZ# PICP.PDF 13. Sediment Erosion Control Development Submittal per the checklist. (http://www.cityofloveland.org/index.aspx?page=1048) 401 Permit; File Name: PZ# 401 Permit.PDF 404 Permit; File Name: PZ# 404 Permit.PDF Acknowledgement Certificate of Receipt; File Name: PZ# Acknowledgement Cert.PDF Agreement for Sediment Erosion Control BMPs; File Name: PZ# Agreement.PDF Construction Dewatering Wastewater Discharge Permit (CDPHE); File Name: PZ# Wastewater Discharge Permit.PDF CDPHE Stormwater Discharge Permit; File Name: PZ# Stormwater Discharge Permit.PDF BMP Cost Opinion Spreadsheet; File Name: PZ# Cost Opinion Spreadsheet.PDF Fugitive Dust Control Permit; File Name: PZ# Fugitive Dust Permit.PDF Stormwater Management Plan & Report (SWMP); File Name: PZ# SWMP.PDF Stormwater Quality Permit Application; File Name: PZ# Stormwater Permit App.PDF Water Quality Control Plan & Report; File Name: PZ# Water Quality Plan.PDF 14. Traffic Worksheet (Not required if submitting a traffic impact study.) http://www.cityofloveland.org/modules/showdocument.aspx?documentid=887 File Name: PZ#Traffic_Worksheet.PDF 15. Traffic Impact Study unless waived by the Transportation Development Review Division. File Name: PZ# TIS.PDF Minor Subdivision Final Plat Checklist Page 3

16. Opinion of Cost signed and sealed by the Applicant s Engineer, prepared in accordance with Chapter 20 of the Larimer County Urban Area Street Standards. (http://www.larimer.org/engineering/gmardstds/ch20_04_01_2007.pdf). File Name: PZ# Cost Opinion.PDF 17. Final Drainage and Erosion Control Report and Plan prepared in accordance with the City of Loveland Storm Drainage Criteria. (http://www.ci.loveland.co.us/index.aspx?page=185). File Name: PZ# Final Drainage.PDF 18. Engineering Deposit to begin the city's electric power design for the site. The deposit must be made payable to the City of Loveland and shall be submitted directly to the Power Division. To determine the amount of the deposit, contact the Power Division at (970) 962-3561. 19. Geotechnical Investigation Report as defined in the Larimer County Urban Area Street Standards. A subsurface water investigation, analysis, and certification shall be provided whenever the geotechnical investigation documents the presence of groundwater within (3) feet of the proposed street subgrade elevations. File Name: PZ# Geotech.PDF REQUIRED ITEMS NOT NEEDED WITH INITIAL APPLICATION 20. List of Surface Owners submitted prior to the required mailing. One copy of a list, certified by the Applicant, of the names and addresses of all surface owners of record of all properties that fall wholly or partially within a 300-foot distance of all boundaries of the property, as the names and addresses appear on the latest records of the Larimer County Clerk and Recorder. Refer to Section 16.18.040.B.3. This list should be current within one month from the date of the required mailing. File Name: PZ# Surface Owners List.PDF 21. Affidavit submitted after the required mailing and posting of signs. An affidavit (Affidavit - Minor Subdivision) certifying that the written notice was given, by first class mail, and a sign(s) was (were) posted on the property in accordance with Section 16.18.040 of the Municipal Code. The written notice shall be in accordance with the template Final Plat Notice Letter, and shall be provided to those property owners on the list required in the items above. The sign(s) shall be posted in a prominent location on the property and shall be in accordance with the sign template provided by the Current Planning Division. File Name: PZ# Affidavit.PDF Minor Subdivision Final Plat Checklist Page 4

MINOR SUBDIVSION APPLICATION Project Name: Narrative Description of Project, including purpose of plat, number of lots, type of use, and other pertinent information: PROJECT Existing Legal Description of Property Boundary (Lots, Blocks, Tracts and Subdivision Name, or Metes & Bounds): Name of PUD (if applicable): Address of Existing Buildings or Property: APPLICANT INFORMATION OWNER S REPRESENTATIVE (CONTACT PERSON) Company: Name: Phone: Fax: Address: City, State: Zip Code: Email Address: CONSULTANT Company: Name : Phone: Address: City, State: Zip Code: Email Address: CONSULTANT Company: Name : Phone: Fax: Address: City, State: Zip Code: Email Address: CONSULTANT Company: Name : Phone: Fax: Address: City, State: Zip Code: Email Address: Minor Subdivision Application Page 5 Fax:

OWNER Company : Name : Phone: Fax: Address: City, State: Zip Code: Email Address: Site Use and Zoning SITE Existing Adjacent Zoning and/or Use Existing Use: Proposed Use: Existing Zoning: North Side: South Side: West Side: Other Information Number of Units Existing: Number of Units Proposed: Number of Lots Proposed: Non-Residential Bldg. Area (Sq. Ft.) Proposed: Total Number of Parking Spaces: East Side: Gross: Right-of-Way: Net: Water: Wastewater: Acreage of Site Utility Services Provided by Is any portion located in a FEMA floodplain? Electric: FEMA FLOODPLAIN * If Yes, please submit legal description Yes No DESIGNATION OF OWNER S REPRESENTATIVE The undersigned owner(s) agree(s) that (please print name) represents the undersigned in all matters pertaining to this project, including subsequent modifications to the application. Owner Signature: Date: ACKNOWLEDGMENTS I, as the Owner or Owner s Representative, hereby acknowledge that the application is correct and complete as per the specifications in the submittal checklist. Owner or Owner s Representative Signature: Date: Printed Name: Minor Subdivision Application Page 6

APPLICATION, APPROVAL, AND RECORDING PROCESS A. Application Submittal: Applications must be submitted electronically (Refer to Development Review Planning and Zoning Application Submittal Instruction Manual). Submittals are checked for completeness by the Development Review Team (DRT) on the next business day following application submittal. The Applicant will be notified by email if the submittal has been accepted or not. If accepted, the application will be assigned to a project planner and given a comment due date. If the application has been determined to be incomplete, the Applicant will be informed of any missing or incomplete items. All project files for submittals that have not been accepted will be deleted and a complete resubmittal of the project, including all electronic files, will need to be submitted for check-in. B. External Agency Review: The city will provide external agencies (private utilities, CDOT, ditch companies) as applicable with the completed application form, a vicinity map, and the proposed subdivision plat. It is the Applicant s responsibility to provide any additional information to the required External agencies for review, including revisions, until the review and approval process is complete. In the event the Applicant is contacted by an external agency representative, the Applicant must provide requested information and documents. C. Mineral Estate Owner Notification: If the property to be platted is subject to severed mineral estates (where other parties own or lease rights to sand, gravel, oil, gas or other minerals beneath the surface of the property), a Planning Commission public hearing is required in accordance with Colorado Surface Development Notification Act (C.R.S. 24-65.5-101 et. seq). The role of the Planning Commission is to conduct a public hearing which affords notice to mineral estate owners and provides them the opportunity to be heard. The Applicant shall send a notice to all mineral estate owners at least 30 days prior to the public hearing. This notice must occur prior to the Director s decision. See the Mineral Estate Owner Letter and Certification (link below) and contact the project planner for information regarding the notification process for severed mineral estates. http://www.cityofloveland.org/modules/showdocument.aspx?documentid=12317 D. Approval Process: The application for minor subdivision is reviewed and approved in accordance with the procedures for a final plat (Section 16.20.080). Once the Applicant has submitted all required materials, the application is referred to the Development Review Team (DRT) for review and comment. If the DRT finds that the submittal is not complete, the Applicant will be informed of the required revisions. If the DRT finds that a complete submittal has been received, the Director will make a final decision on the final plat application by approving, approving with conditions, or denying the application using review standards in 16.20.030, subject to appeal. Note: If the final plat pertains to a qualifying surface development (defined in CRS 24-65.5-102(5.7) as at least one hundred sixty gross acres, plus or minus five percent, in the greater Wattenberg area, including property in a single application owned by affiliates sharing a common boundary, in whole or in part), then the Director s decision will not be made until 30 days after the public hearing described in C above. E. Notice requirements: Once the Director makes a decision, the Applicant sends a notice (see Sample Neighborhood Mailing Letter found in this checklist by first class mail to the owners of property within 300 feet of the boundary of the property being subdivided. The written notice describes the general nature of the application and informs the recipients that they have standing to appeal the Director s decision. Note that the date of the Director s decision must coincide with the postmark date for the notices mailed by the Applicant. Additionally, the Applicant must post one or more notification signs on the property. The sign(s) must be prepared in accordance with the sign template provided by the project planner. Application, Approval, and Recording Process Page 7

F. Appeal Period: Once the Director makes a preliminary decision on the final plat and all required notices have been given, a 10-day time period begins in which the Director s decision may be appealed by the Applicant, any property owner who was required to receive mailed notice of the Director s decision, three or more members of the Planning Commission, or three or more City Councilors. 1. No Appeal: If no appeal is filed within the 10-day appeal period, the Applicant must submit the documentation required in G below and the Director will sign the final plat Applicant. The final plat will be recorded with the Larimer County Clerk and Recorder by the Loveland City Clerk. 2. Appeal: If a timely appeal is filed, the Current Planning division will schedule a public hearing for the appeal to be heard by the Planning Commission between 30-60 days after notice of appeal is filed (in compliance with Chapter 18.80 of the Loveland Municipal Code). G. Final Document Submittal: After the appeal period has concluded, the Applicant shall make any Water Rights Payments as required. Then the following final documents shall be submitted by the Applicant. a. One digital copy of the final plat mapping data in the format per the requirements in Plat and Map Digital Submission Standards b. Two original 24 x 36 signed and sealed mylars of the subdivision plat containing signatures of all record owners and lienholders, the Applicant s attorney, and Colorado Professional Surveyor; c. One original signed Development Agreement, if applicable; d. One Final Drainage and Erosion Control Report and Plan, original hardcopy, if applicable, signed and sealed by a Colorado Professional Engineer; e. One set Final Public Improvement Construction Plans, original hardcopy, if applicable, signed and sealed. The final construction drawings must be approved by the city and any other providers of utilities (with signatures) prior to the recordation of the final plat. Each sheet must be wet stamped and signed by the Colorado Professional Engineer, and landscape plans must be signed and sealed by a Colorado Landscape Architect. Signatures must also be provided of any External Agencies approving the plan prior to City approval; f. One Traffic Impact Study (TIS), original hardcopy, signed and sealed by a Colorado Professional Engineer, if applicable; g. One Opinion of Cost, original hardcopy, signed and sealed by a Colorado Professional Engineer, if applicable. For more information, please see the Review and Decision Process flow chart on the City of Loveland website. Application, Approval, and Recording Process Page 8

FINAL PLAT REQUIREMENTS All Final plats shall comply with the following standards: 1. All plats must bear suitable evidence of the professional qualifications of the person or firm who prepared the plat. Plans containing water supply, sanitation, utilities, soils, grading, roads, structures, and other civil engineering work shall be certified by a duly registered Colorado Professional Engineer. All required documents containing land survey descriptions shall be certified by a duly registered Colorado Professional Land Surveyor. All topographic plans shall be certified by a duly registered Colorado Professional Engineer or Colorado Professional Land Surveyor. All data submitted regarding environmental studies and other disciplines, not currently requiring registration by the State of Colorado, must be accompanied by a resume of such qualifications sufficient to demonstrate the author s degree of expertise and experience. Geology plans and reports shall be prepared and certified by a qualified Geologist or registered Colorado Professional Engineer with documentable experience in geotechnical engineering satisfactory to the city. 2. Monuments. The character, type and position of all boundary and/or aliquot monuments found or set shall be shown on the plat. New street centerline monuments shall be shown for all street intersections, points of curvature, angle points, intersections of street centerlines with the boundary of the subdivision and points that define the geometry of the cul-de-sacs. Reference monuments shall be set, with dimensions and descriptions shown on the plat in the event that monuments cannot practically be set because of steep terrain, water, marsh or existing structures. If a monument is to be set as a result of a proposed street, road, or other construction, one or more reference monuments shall be set, with dimensions and descriptions shown on the plat, if the monument cannot be reestablished in its original position. 3. A monument key that shows existing monuments in the form of those monuments found and those set, as well as those to be set upon completion of street construction or a note at each monument detailing this information is acceptable. 4. Section Corner Tie. Where the location of a subdivision or piece of property is required to be shown as a part of some larger subdivision or tract of land, such subdivision or piece of property shall be shown by reference to permanent survey monuments with the original subdivision or tract. A minimum of two section corners, quarter corners or other relevant aliquot corners are required for major subdivision plats. 5. The dimensions of all plats shall be twenty-four (24) inches by thirty-six (36) inches, with a marginal line one inch from each edge. All drawings, affidavits, certificates, acknowledgments, endorsements, acceptances of dedication and notarial seals shall be contained within said marginal lines, except that the title shall be noted in the upper and lower right corners, outside the margin, for city filing purposes. 6. In the case of three or more sheets, a key map showing the relationship of individual sheets shall be provided on the first sheet of the set. Match lines are required on each sheet of a set. Notes shall appear only on the first sheet. 7. Each plat shall be drawn in black, waterproof ink on Mylar of good quality. 8. The basis of bearings used in the legal description, noted and shown. 9. The proposed name of the subdivision. 10. A subtitle describing the origin of the proposed subdivision. 11. Date of preparation. Neighborhood Mailing Letter Page 9

12. A written legal metes and bounds description of the exterior boundaries of the land parcel. 13. A scale drawing of all boundaries of the land parcel with the Point of Commencement (or Point of Beginning) and Point of Beginning (or True Point of Beginning) clearly labeled. 14. A statement defining the lineal units used. 15. A title commitment note if research for all easements and rights-of-way was completed by someone other than the Colorado Professional Land Surveyor who certifies this plat. 16. Each sheet shall show title, north arrow, scale (minimum 1 = 100 or as determined by the Director), bar graph, and sheet number. 17. Show relationship to adjacent areas using fine dashed lines to include complete legal description (lot and block numbers, outlot and tract names and subdivision name or unincorporated Larimer County ), including land across adjacent right-of-ways. 18. Boundary of the subdivision shall be designated by a one-eighth inch hatched border applied to the inside of the bold boundary line. 19. Line types for subdivision boundary, street right-of-way lines and lot lines shall be bold and solid. 20. Line types for easements shall be denoted by fine dashed lines. 21. Location and widths of all existing recorded, non-recorded and proposed easements are to be labeled and dimensioned to sufficiently define the easement geometry, including easements to be reserved for public use. No typical notations shall be used. Where an easement is not defined as to width or extent by a recorded conveyance, decree or other instrument, the easement shall be depicted in a manner that gives notice of the existence thereof, together with an appropriate descriptive label which includes the words boundary not determined. It shall be the duty of the Applicant to meet with the owner of each such easement and to make reasonable efforts to agree upon boundaries thereof. In the event any such agreement is reached, appropriate instruments evidencing such agreement shall be recorded prior to recording of the final plat, and the agreed upon boundaries shall be indicated on the final plat. 22. Postal easements shall have a minimum width of six (6) feet and shall be provided along all street frontages unless waived in writing by the Loveland Postmaster. 23. Location and dimensions of all existing recorded and proposed right-of-ways, showing the centerline of each right-of-way and the right-of-way width on each side of centerline. 24. Future street dedication. Whenever construction of a street is necessary for future re-subdivision as determined by the city, but which street is not warranted for construction, the necessary dedication for such future street shall be provided on the plat. 25. Location and dimensions for all lines, angles and curves used to describe boundaries, alleys, lot lines, access points to public ways, open areas, easements, areas to be reserved for public use and other important features shall be provided. Sufficient data shall be shown to readily determine the bearing and length of every lot line, boundary line and easement line. No ditto marks shall be used. Length, radius, total delta and the bearing of radial lines to each lot corner on a curve shall be shown. In addition, non-tangent curves shall include a chord bearing and distance. 26. All distances shall be set forth to the nearest hundredth of a foot and bearings to the nearest second. Neighborhood Mailing Letter Page 10

27. All lots, tracts, and outlots shall show net acreage to the nearest square foot. 28. Block and lot numbers. Lots shall be designated numerically, in bold, beginning with the number 1, in each block. Groups of lots surrounded by a street or other recognized feature shall be designated as separate blocks. The block or blocks shall be designated numerically in bold, beginning with the number 1, in each block. 29. Street names, including prefixes and suffixes, as per Section 12.08 of the Loveland Municipal Code. Names to be used for new streets shall be subject to street naming policy of the city and all names shall be subject to the approval of the Director/Planning Commission, and Fire and Police Departments. 30. Limits of FEMA floodway and flood fringe boundaries shall be shown by dashed lines and labeled. 31. The centerline and directional flow of streams and rivers shall be shown with dashed lines ending with arrows and with an appropriate descriptive label including the words exact location not determined. The Public Works Department may require information, including but not limited to additional right-ofway, flood plain information, etc. 32. All irrigation ditches and proposed easements and right-of-ways for irrigation ditches. If no easements or right-of-ways exist, the plat shall show the location of any such ditch on the plat with appropriate descriptive label including the words exact location not determined. 33. Legal description of the subdivision parcel inclusive of the reception number(s) and book and page(s) that the legal survey for the subdivision is based upon. Legal descriptions must match boundary and direction shown on the plat. The area of the subdivision shall be included in the legal description and dedication statement. 34. Other relevant documentation or information as determined or required by the Director to make a determination as to the impacts of the proposed subdivision to the city. 35. When a development agreement has been established for a project, the following note shall be provided on the plat: This project is subject to a development agreement which has been recorded in the real property records of Larimer County. 36. Previous conditions reference. The following note shall be provided on all new plats of previously subdivided property: Unless otherwise approved by the city, all unsatisfied conditions of approval for the original subdivision shall continue to apply to this property. 37. Improvement statement. If applicable, the final plat shall have a statement stating who will pay for the installation of the improvements to be placed in or upon the property shown on such plat as follows: All expenses involving necessary improvements for water system, sanitary sewer system, storm sewer system, curbs and gutters, sidewalks, street improvements, street signs, traffic control signs, alley grading and surfacing, gas service, electric system, grading and landscaping shall be paid by (insert name of owners). 38. A note which explains the ownership and maintenance responsibility for side and rear lot drainage easements (i.e. publically owned, privately maintained by the adjacent property owners). 39. A note which states the following: Maintenance and upkeep of Stormwater detention ponds, storm sewer systems, swales, and permanent Stormwater quality improvements are required by the City of Loveland and are a continuing obligation of the Homeowner Association (HOA), Business Owner Association (BOA), or private property owner. The owner(s) or responsible parties (HOA, BOA) shall provide ongoing maintenance to the private Stormwater improvements as needed to maintain compliance with the approved construction plans and reports. Neighborhood Mailing Letter Page 11

40. The following notes with the appropriate square footage for dedication and/or vacation of easements shall be included. If no easements are dedicated or vacated, please enter 0 as the necessary value. Total area in square feet of easements dedicated to the public or the city by this plat. Total area in square feet. (Excluding easements dedicated exclusively to outside entities or agencies.) Total area in square feet of easements dedicated to the public or city that is being vacated by this plat. Total area in square feet. Final Plat Requirements Page 12

41. Dedication form-acknowledgements. All maps, on which property is dedicated for public use, shall have a dedication statement thereon signed by all persons having any record interest in the property annexed, consenting to the preparation and recording of the map and offering for dedication all parcels of land shown on the map and intended for any public use, except those parcels other than streets which are intended for the exclusive use of the lot owners in a subdivision of the property contained within the boundaries of the annexation map, including their licensees, visitors, tenants and servants. The form of all dedications and the acknowledgments of all signatures shall be as shown on Certificate No. 1. Certificate No. 1: Dedication/Acknowledgments KNOW ALL PERSONS BY THESE PRESENTS that (the undersigned), being all the owners and lien holders of the following described property, except any existing public streets, roads or highways, which property is located in Section, Township North, Range West of the 6 th P.M., being more particularly described as follows: containing (acres)(square feet) more or less, and is subject to all easements and rights-of-way on record or existing, do hereby subdivide the same into lots, blocks, tracts, outlots, rights-of-way and easements, as shown on this plat; and do hereby designate and dedicate: (1) all such rights-of-way and easements, other than utility easements and private easements, to and for public use, except where indicated otherwise on this plat; and (2) all such utility easements to and for public use for the installation and maintenance of utility, irrigation and drainage facilities; and do hereby designate the same as (insert that portion of the title of the plat, up to and including the words to the City of Loveland, Colorado ). Owner s Signature(s) Lienholder s Signature(s) STATE OF COLORADO ) ) ss. COUNTY OF LARIMER ) The foregoing instrument was acknowledged before me this day of, 2, by as. Witness my hand and official seal. My commission expires Notary Public Final Plat Requirements Page 13

42. Surveyor s certificate. The form of all surveyors certificates, together with the acknowledgment, shall be as shown on Certificate No. 2. Certificate No. 2: Surveyor I, (printed name of land surveyor), being a registered Professional Land Surveyor in the State of Colorado, do hereby certify that the survey of (name of plat in capital letters) was made by me or under my supervision and that the survey is accurately represented on this plat and that the statements contained hereon were read by me and the same are true to the best of my knowledge. Dated this day of, 2. 43. City certificate as shown on Certificate No. 3. Certificate No. 3: City of Loveland This plat is approved by the Director of Development Services of the City of Loveland, Larimer County, Colorado, this day of, 2, for filing with the Clerk and Recorder of Larimer County and for conveyance to the City of the public dedications shown hereon, which are accepted; subject to the provision that approval in no way obligates the City of Loveland, for the financing or constructing of improvements on land, streets, or easements dedicated to the public except as specifically agreed to by the Director of Development Services. Director of Development Services Witness my hand and seal of the City of Loveland. ATTEST: City Clerk Final Plat Requirements Page 14

44. Applicant s Attorney s certificate as shown on Certificate No. 4. Certificate No. 4: Applicant s Attorney I,, an attorney licensed to practice law in the State of Colorado, certify that I have examined title to the above described land dedicated to the City of Loveland, Colorado, with such land described in Schedule A to Title Commitment No., issued by effective, 20, and that in my professional judgment and knowledge based on such title commitment updated through the date of execution of this plat and my actual knowledge, all persons executing the dedication of this plat are the owners or duly authorized signatories of such land in fee simple, such land is free and clear of all liens and encumbrances, except encumbrances set forth in Schedule B Section 2 of such title commitment as of such date of execution, and any such encumbrances do not impair the use of such land for the purposes set forth on this plat. So sworn this day of, 2 Attorney at Law Final Plat Requirements Page 15