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Table 15T-03

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(Referred from LMC 15.10.260(C))

I hereby certify that the plat of _______________ is based upon an actual survey and subdivision of a portion of Section _______________, Twp. __________, Range __________ E or W, W.M.; that the distances and courses shown thereon are correct; that the monuments have been set and lot and block corners staked on the ground.

___________________________________

1.

Certificate--City Engineer.

Examined and approved this __________ day of _______________ 20 ___.

___________________________________

City Engineer

2.

Certificate--Health Officer.

Examined and approved this __________ day of _______________ 20 ___.

___________________________________

Title

NOTE.–Health Officer signature is not required when potable water and sanitary sewer are provided by the City.

3.

Certificate--Assessor.

Examined and approved this __________ day of _______________ 20 ___.

___________________________________

Thurston County Assessor

4.

Certificate--Treasurer.

I hereby certify that all taxes on the land described hereon have been fully paid to and including the year ____________________.

___________________________________

Treasurer, Thurston County

5.

Certificate--City Planner.

Examined and approved this __________ day of _______________ 20 ___.

___________________________________

City Planner

6.

Certificate--Mayor for Lacey City Council.

Examined and approved this __________ day of _______________ 20___.

Lacey City Council

By ________________________________

Mayor

Attest:

__________________________________

City Clerk

7.

Certificate--County Auditor.

Filed for record at the request of ____________________ this day __________ day of _______________, 20___, at __________ _____m. and recorded in Volume _____ of Plats, on Page _____, records of Thurston County, Washington.

___________________________________

Thurston County Auditor

___________________________________

Deputy Auditor

(Ord. 1480 §8 (part), 2015; Ord. 1427 §11 (part), 2013).