A. 
I hereby certify that ___________________ is the owner of the land herein subdivided or to be developed and that I do hereby adopt this plan.
(Title)
B. 
I hereby certify that _______________ is the developer of the land herein developed and that I do hereby adopt this plan.
(Name, Title)
C. 
Approved by the Whitpain Township Planning Commission this _____ day of _____________________, 20 _____________.
Secretary
Whitpain Township
Planning Commission
D. 
Approved by the Township Engineer on the day of _____________, 20 _____.
 
Township Engineer
E. 
Approved by the Board of Supervisors of Whitpain Township this ________ day of _________________, 20 __________.
Chairman
Secretary
F. 
I hereby certify that this plan represents a survey made by me, that the monuments shown hereon exist as located and that all dimensional details are correct.
__________
Date
Registered Engineer or Surveyor (SEAL)
G. 
Submitted herewith are a complete set of profiles and cross sections marked ______ which form a part of this application, being dated ____________ and revised ____________________________.
Developer
H. 
Upon completion of this project there is offered for dedication the following:
Developer
I. 
Owner's acknowledgment:
STATE OF PENNSYLVANIA
COUNTY OF MONTGOMERY
On the ____________ day of ____________, 20 ____ before me, the subscribed, a Notary Public of the Commonwealth of Pennsylvania residing in (___),
personally appeared ___________________ who acknowledged this plan to be the official plan of the highways and property shown thereon situate in the Township of Whitpain, Montgomery County, Pennsylvania, and desired that this plan be recorded according to law.
Witness my hand and notarial seal the day and year aforesaid.
__________________________
Notary Public
My Commission Expires:
_____________________________, 20 ____
J. 
Developer's acknowledgement:
On this, the ___________ day of _________________, 20 ____, before me, the undersigned officer, a Notary Public, personally appeared ______________ known to me or satisfactorily proven to be the _____________ of __________________________, whose name is subscribed to the within instrument, and acknowledged that he/she executed the same on behalf of the corporation for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notary Public
My Commission Expires: ____________, 20 __________
K. 
Recorded plan.
Recorded this ________________ day of ____________, 20 ___, in the Office for the Recording of Deeds, etc., in and for the County of Montgomery of Norristown, Pennsylvania, in Plan File Case ____ D.B. No ___ Page _______________.
Recorder
L. 
Capped sewers required. See Profile #__________ Date___________
M. 
Approved by:
__________________
Township Engineer
Date
N. 
The following improvement construction drawings are to be used in conjunction with record plan:
___________________
Title
Date
___________________
Revision Date
O. 
Acknowledgment for use by corporation (sample attached).
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF _____________
On this, the _________________ day of _______________, 20_____, before me, ________________________, the undersigned officer, personally appeared ____________________, who acknowledged himself (herself) to be the _________________ of ______________, a corporation, and that he as such ________________, being authorized to do so, executed the foregoing instrument for the purpose therein contained by signing the name of the corporation by himself (herself) as
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notary Public
My Commission Expires:
__________________ 20 _____
P. 
Deferral of Improvement Note:
Installation of those improvements including curb, sidewalk, street widening and storm sewer along the tract frontage(s) by the property owner/developer is hereby deferred until such time it is deemed necessary by the Whitpain Township Board of Supervisors, without the need for adoption of an ordinance or assessment. Within 90 days of written notice from the Board of Supervisors, owner/developer agrees to:
(1) 
Obtain all necessary permits that are applicable to the work;
(2) 
Install curb, sidewalk, street widening or storm sewer at no expense to Whitpain Township;
(3) 
Waive any rights to contest a lien by Whitpain Township if curb, sidewalk, street widening or storm sewer installation is not completed within ninety-day period, weather permitting. Installation of curb and related construction shall conform to the applicable Township and PennDOT construction standards, in force at the time of notice.