HomeMy WebLinkAboutBANNER HEALTH MEDICAL CAMPUS - PDP - PDP130003 - SUBMITTAL DOCUMENTS - ROUND 1 - SITE PLANHARMONY RD
SITE
ZIEGLER RD
LAND USE: HC
LAND USE: POL
LAND USE: T
LAND USE: LMN
LAND USE:
UE
LAND USE: RL
LAND USE:
UE
INTERSTATE 25
LADY MOON DR.
DISH
PROPOSED BUILDING ENVELOPE
FUTURE BED TOWER
PHASE 1 BED TOWER
PROPOSED MEDICAL
OFFICE BLDG
30,000 SF
1 STORY
115 STAFF PARKING
223 PUBLIC PARKING
194 STAFF PARKING
170 FUTURE PARKING
FUTURE
MEDICAL
OFFICE BLDG
2 STORY
40,000 SF
PROPERTY BOUNDARY / R.O.W
PROPERTY BOUNDARY / R.O.W
HARMONY ROAD
LADY MOON DRIVE
CINQUEFOIL LANE
40 PUBLIC PARKING
HELI-STOP
SERVICE
ENTRY
PLAZA
COURTYARD
COURTYARD
FULL
MOVEMENT
ACCESS
FULL
MOVEMENT
ACCESS
FULL
MOVEMENT
ACCESS
FULL
MOVEMENT
ACCESS
PROPERTY BOUNDARY / R.O.W
PROPERTY BOUNDARY / R.O.W
PROPOSED HOSPITAL
TEMPORARY EMERGENCY
ALL WEATHER ACCESS ROAD
8" W 8" W 8" W
12" W
12" W 12" W
12" W 12" W 12" W
12" W 12" W
12" W 12" W 12" W
12" W
12" W 12" W 12" W 12" W 12" W 12" W 12" W
12" W 12" W 12" W 12" W 12" W 12" W 12" W 12" W 12" W 12" W
12" W
12" W 12" W 12" W 12" W 12" W 12" W 12" W
G
G
G G G
G
G
G
G
G
G
G
G
G
G
G
G G G G G G G G G G G G G G G G
E
E E E E E
E
E E E E E
E
E E E E E
E
E
E
E
G
G
G
G
G
G
G
G
FO FO FO
FO FO
FO FO FO
FO
FO
FO
FO
FO
FO
149'-3"
30'
30'
36'
24'
24'
19' 19' 24' 19' 19' 24' 17' 8' 17' 24' 19' 19'
8" W
8" W 8" W 8" W
8" W 8" W 8" W 8" W 8" W 8" W
8" W 8" W
8" W
8" W
8" W
8" W 8" W 8" W 8" W 8" W
8" W 8" W 8" W 8" W
12" W 12" W
12" W
12" W 12" W 12" W 12" W 12" W
12" W
8" F
8" W
8" W
E E
E
E
E E E E E E E E E
E
E E E E E
G
G
G
G
G
G
G
G
G
G
G
G
G
G
G
G
G G
G
G
FO/T FO/T FO/T
FO/T FO/T FO/T FO/T FO/T FO/T
FO/T
FO/T
FO/T
FO/T
FO/T
FO/T
FO/T
FO/T
17' 24' 19' 19' 24' 19' 19' 24' 19' 19' 30' 17'
9'
30' 17'
18'
12'
7'
7'
17'
30' 19' 19' 24' 19' 19' 24' 19' 19' 24' 19' 19' 24' 17'
DISH
G
G
G
G
G
G
G G G G G G
E E
E
E E E E
E
E E E E E E E
E
E
G
G
G
G
G
G
G
G
G
G
G
G
CTV
CTV
LE FEVER DRIVE (PLANNED)
HARMONY ROAD
LADY MOON DRIVE
CINQUEFOIL LANE
FUTURE SITE IMPROVEMENTS
FUTURE
STAFF
PARKING
FUTURE
BUILDING
INFILL
FUTURE
BUILDING
EXPANSION
FUTURE
BUILDING
EXPANSION
FUTURE
BUILDING
EXPANSION
FUTURE
BUILDING
FUTURE
PARKING
FUTURE
PARKING
EXPANSION
TEMPORARY ALL WEATHER
ACCESS ROAD (NOT PUBLIC)
FIRST PHASE
BUILDING FIRST PHASE
0 50' 100' 200'
BHA Design Incorporated
1603 Oakridge Drive
Fort Collins, Colorado 80525
voice: 970.223.7577
fax: 970.223.1827
DISH
6"PVC
12"PVC
12"PVC
FOR IRRIGATION
w/ VALVE
12"PVC
FOR IRRIGATION
12"PVC FOR IRRIGATION
8"PVC
8"PVC
2"PVC
MONITERING WELL
WIRE FENCE
WOOD FENCE
WIRE FENCE
METAL
FENCE
WOOD FENCE
WOOD FENCE WOOD FENCE
WOOD FENCE
WIRE FENCE
WOOD FENCE
WOOD FENCE
WOOD FENCE WOOD FENCE
ELECTRICAL FENCE
BARBED WIRE FENCE
BARBED WIRE FENCE
BARBED WIRE FENCE
BARBED WIRE FENCE
BARBED WIRE FENCE
BARBED WIRE FENCE BARBED WIRE FENCE
BARBED WIRE FENCE
CHAINLINK FENCE
BARBED WIRE FENCE
BARBED WIRE FENCE
CHAINLINK FENCE
WIRE FENCE
WIRE FENCE
BARBED WIRE FENCE
BARBED WIRE FENCE
BARBED WIRE FENCE
CHAINLINK FENCE
BARBED WIRE FENCE
WIRE FENCE
2"PVC w/ VALVE
3"PVC
0.75"METAL
w/ NOZZLE
(2) 1"METAL
CONNECTED w/ VALVE
3"PVC 0.75"METAL
w/ NOZZLE
(2) 1"METAL
CONNECTED w/ VALVE
8"PVC
12"PVC
FOR IRRIGATION
w/ VALVES
3' DIA. METAL DRUMS
2' HIGH
4"PVC
T POST
SANITARY SEWER STUB
4"PVC
1.5"PVC &
1"METAL
CONNECTED
(3) 2' x 3.5'
INLET GRATES
(3) 2' x 3.5'
INLET GRATES
SANITARY MANHOLE
RIM = 4910.96'
N 8"PVC = 4896.16'
S 8"PVC = 4895.87'
SANITARY MANHOLE
RIM = 4898.58'
N 12"PVC = 4886.80'
S 12"PVC = 4886.70'
SANITARY MANHOLE
RIM = 4903.04'
E 8"PVC = 4888.90'
N 12"PVC = 4888.37'
S 12"PVC = 4888.34'
SANITARY MANHOLE
RIM = 4905.14'
N 8"PVC = 4890.29'
W 8"PVC = 4890.22'
S 12"PVC = 4890.14'
SANITARY MANHOLE
RIM = 4912.61'
W 8"PVC = 4898.22'
S 10"PVC = 4898.11'
SANITARY MANHOLE
RIM = 4907.23'
N 8"PVC = 4891.75'
S 8"PVC = 4891.57'
SANITARY MANHOLE
RIM = 4899.85'
E 6"PVC = 4888.33'
S 12"PVC = 4887.88'
2 STORY
WOOD /
BRICK
COVERED
BRICK PATIO
ENCLOSED
PORCH
WOOD
BARN
WOOD
SHED METAL
STABLE
METAL
SHED
GARAGE
1 STORY
WOOD / BRICK
WOOD
SHED
METAL SHED
SANITARY MANHOLE
RIM = 4909.08'
N 8"PVC = 4894.17'
S 8"PVC = 4894.07'
12"PVC
FOR IRRIGATION
w/ VALVE
4"PVC
12"PVC
FOR IRRIGATION
w/ VALVE
12"PVC
FOR IRRIGATION
w/ VALVES
FL 10"PVC ELEV. = 4909.05'
FL 10"PVC ELEV. = 4908.66'
15"CMP
FL W = 4901.57'
FL E = 4901.49'
FL 24"RCP ELEV. = 4907.29'
FES 24"RCP
4903.38'
FES 24"RCP
4905.25'
FES 15"RCP
4906.94'
FES 15"RCP
4900.47'
FES 24"RCP
4902.67'
FES 24"ADS
4908.53'
12"RCP
W = 4902.83'
E = 4902.30'
18"RCP
4906.18'
18"PVC
W = 4903.07'
E = 4902.96'
12"CMP
W = 4875.85'
E = 4875.04'
12"CMP
N = 4902.53'
S = 4902.40'
12"CMP
N = 4902.26'
S = 4902.00'
STORM BOX
RIM = 4912.98'
(2) W 10"PVC = 4907.69'
S 15"PVC = 4905.77'
FL 10"PVC ELEV. = 4909.07'
INLET GRATE
RIM = 4908.93'
SE 15"PVC = 4907.56'
INLET GRATE
RIM = 4911.71'
E 24"x36"ELLIP.RCP = 4907.10'
STORM MANHOLE
RIM = 4909.71'
W 24"x36"ELLIP.RCP = 4904.58'
E 24"x36"ELLIP.RCP = 4904.48' FES 24"x36"ELLIP. = 4901.05'
FES 24"ADS
4907.92'
STORM MANHOLE
RIM = 4908.28'
E 24"RCP = 4903.66'
N 24"RCP = 4903.64'
STORM MANHOLE
RIM = 4906.75'
N 30"RCP = 4898.12'
S 30"RCP = 4898.05'
STORM MANHOLE
RIM = 4908.61'
N 24"RCP = 4899.28'
S 30"RCP = 4899.19'
W 15"RCP = 4899.18'
STORM MANHOLE
RIM = 4909.74'
E 24"RCP = 4905.22'
SW 24"RCP = 4905.17'
STORM MANHOLE
RIM = 4910.90'
W 24"RCP = 4902.97'
S 24"RCP = 4902.94'
STORM MANHOLE
RIM = 4911.20'
N 24"RCP = 4900.98'
S 24"RCP = 4900.95'
STORM INLETGRATE
RIM = 4909.77'
W 24"RCP = 4905.44'
STORM INLET
RIM = 4907.44'
E 12"x24"ELLIP.RCP = 4904.30'
W 24"RCP = 4904.27'
STORM INLET
RIM = 4907.31'
W 12"x24"ELLIP.RCP = 4904.41'
15" CMP FES
INV=4897.13
18" CMP FES
INV=4886.05
"SPEED LIMIT 55"
"DO NOT ENTER"
"WRONG WAY"
"YIELD"
"YIELD"
LEVEL 3
FIBER
"RIGHT LANE MUST TURN RIGHT"
"CAUTION"
"CAUTION"
"CAUTION; KEEP RIGHT"
"CAUTION; KEEP RIGHT"
"BIKEWAY; RIGHT LANE BIKES ONLY"
"SPEED LIMIT 30"
"RIGHT LANE MUST TURN RIGHT"
"CAUTION"
"ROAD CLOSED;
EMERGENCY ACCESS ONLY"
"STOP"
"HARMONY TECHNOLOGY CENTER"
BARRICADE
#4 REBAR w/CAP
LS# 33193
#4 REBAR NO CAP
BENT
#4 REBAR NO CAP
#4 REBAR NO CAP
#5 REBAR w/CAP
LS# 37963
#5 REBAR w/CAP
LS# 37963
#5 REBAR w/CAP
LS# 37963
#5 REBAR w/CAP
LS# 37963
#5 REBAR w/CAP
LS# 37963
#5 REBAR w/CAP
LS# 37963
3-1/4" ALUMN. CAP
CDOT MILEPOST 3.59
#5 REBAR w/CAP
LS# 37963
FND #4REBAR
w/PLASTIC CAP
LS 12374
FND #5 REBAR
w/PLASTIC CAP
LS 37963
0 50' 100' 200'
BHA Design Incorporated
1603 Oakridge Drive
Fort Collins, Colorado 80525
voice: 970.223.7577
fax: 970.223.1827
BUILDING
FIRST PHASE
BUILDING
EXISTING RESIDENCE TO BE USED DURING PHASE
ONE CONSTRUCTION FOR FIELD OFFICE.
FUTURE SITE IMPROVEMENT AREA:
MINIMAL INTERIM SITE IMPROVEMENTS
FIRST PHASE: EXTENT OF BUILDING
CONSTRUCTION
GENERAL NOTES
1. SITE IMPROVEMENTS SHALL BE AS NEEDED BY PHASE.
2. AREAS INDICATED AS FUTURE PHASE MAY BE DEVELOPED IN ONE OR
MORE PHASES.
0 50' 100' 200'
BHA Design Incorporated
1603 Oakridge Drive
Fort Collins, Colorado 80525
voice: 970.223.7577
fax: 970.223.1827
LEGEND
24'
17'
11'-0
1
2"
30'
183'-5"
30' 17'
TOTAL AREA: 74,457 SF.
LANDSCAPE AREA: 7,602 SF.
LANDSCAPE AREA = 10.2%
TOTAL AREA: 68,383 SF.
LANDSCAPE AREA: 6,976 SF.
LANDSCAPE AREA = 10.2%
DETENTION / WATER QUALITY BASIN
PHASE 1
BED TOWER
PROPOSED (8)
BIKE PARKING
PROPOSED (6)
PROPOSED BIKE PARKING
TRANSIT
STOP
PROPOSED
DINING PATIO
PROPOSED TRASH
/ RECYCLING
ENCLOSURE
5'
PROPOSED (6) BIKE PARKING
PROPOSED (4) BIKE
PARKING, COVERED
PROPOSED (8)
BIKE PARKING
LE FEVER DR (PLANNED)
FUTURE MEDICAL
OFFICE BUILDING
2 STORY
40,000 SF
ASPHALT PARKING
ASPHALT PARKING
PRIVATE DRIVE
PRIVATE DRIVE
PROPOSED WALK, 5' TYP.
PROPOSED
COURTYARD
UTILITY
EASEMENT
UTILITY
EASEMENT
CINQUEFOIL LANE
PROPOSED WALK
PROPOSED LIGHTING
TYP., RE: CIVIL
C
PROPOSED
STORM LINE
RE: CIVIL
PROPOSED
SANITARY LINE
RE: CIVIL
PROPOSED FIBER
OPTICS LINE
RE. CIVIL
PROPOSED
WATER LINE,
RE: CIVIL
PROPOSED
ELECTRIC LINE,
RE: CIVIL
PROPOSED UTILITY
EASEMENT RE: CIVIL
FUTURE
PHASE BED
TOWER
PROPOSED WATER
LINE, RE: CIVIL
PROPOSED FIRE
WATER, RE: CIVIL
PROPOSED FIBER
OPTICS, RE: CIVIL
PROPOSED SANITARY
LINE, RE: CIVIL
PROPOSED STORM
LINE , RE: CIVIL
PROPOSED GAS
LINE, RE: CIVIL
PROPOSED STORM
LINE, RE: CIVIL
9'
BIOSWALE
PROPOSED WATER
LINE, RE: CIVIL
PROPOSED FIRE
WATER, RE: CIVIL
PROPERTY BOUNDARY / R.O.W
LIMITS OF WORK
PROPERTY
BOUNDARY
/ R.O.W
LIMITS OF
WORK
PROPOSED WALK
& CROSS WALKS
C
B
C
C
B
B
LADY MOON DRIVE
EXISTING TREES TO BE
REMOVED OR RELOCATED
A
B
C
E F G H WALL
SIGN
DIRECTIONAL
SIGN
DIRECTORY SIGN
MAIN ID
MONUMENTS
0 20' 40' 80'
BHA Design Incorporated
1603 Oakridge Drive
Fort Collins, Colorado 80525
voice: 970.223.7577
fax: 970.223.1827
LEGEND
1. TYPICAL HEAD TO HEAD PARKING STALLS ARE 9'x19'. WHERE VEHICLES OVERHANG LANDSCAPE, TYPICAL PARKING
STALLS ARE 9'x 17'.
2. SITE IMPROVEMENTS AS NEEDED BY PHASE
NOTES
SIGN KEY
MATCH LINE
24' 19' 19' 24' 17'
24'
30'
24'
459'-51
2"
17' 24' 19' 19' 24' 17'
24'
19' 24' 19' 19' 24' 17'
20' 20' 20'
44'-11
2"
20'
80'
80'
17'
9'
17',
TYP.
24'
24'
24'
30'
20'
12'
18'
8'
148'
140'
TOTAL AREA: 37,860 SF.
LANDSCAPE AREA: 3,955 SF.
LANDSCAPE AREA = 10.4%
TOTAL AREA: 19,788 SF.
LANDSCAPE AREA: 4,167 SF.
LANDSCAPE AREA = 21%
TOTAL AREA: 87,371 SF.
LANDSCAPE AREA: 9,302 SF.
LANDSCAPE AREA = 10.6%
DETENTION / WATER QUALITY BASIN
80' HARMONY ROAD SETBACK
CONCRETE HELI-STOP
140' X 148' SAFETY ZONE
(5) EMERGENCY
VEHICLE PARKING
(2) EMERGENCY
VEHICLE PARKING
(2) EMERGENCY
VEHICLE PARKING
MEDICAL OFFICE BUILDING
CENTRAL UTILITY
PLANT
FUTURE PHASE
DIAGNOSTICS
AND TREATMENT
EMERGENCY
DEPARTMENT
AMBULANCE DRIVE:
ONE WAY
EMERGENCY DEPARTMENT
PARKING: ONE WAY DRIVE
SERVICE DRIVE
PROPOSED
(30) BIKE
PARKING
(6) COVERED
PROPOSED (8)
BIKE PARKING
PROPOSED
TRANSIT STOP
8'
9', TYP.
PAINTED CROSSWALK, TYP.
SPECIAL CROSSWALK, TYP.
7'
5'
9'
24'-3"
39'-6"
12'
12'
INTERIOR COURTYARD
5' 5'
5' 7'
ACCESSIBLE PARKING
ACCESSIBLE PARKING
ACCESSIBLE
PARKING
20'
11'-2"
PROPOSED
(6) BIKE
PARKING
PROPOSED
(8) BIKE
PARKING (8
COVERED)
HARMONY ROAD
LADY MOON DRIVE
HOSPITAL
3 STORY
6)
PHASE ONE
6)
DRAINAGE
EASEMENT
UTILITY
EASEMENT
UTILITY
EASEMENT
CINQUEFOIL LANE
ASPHALT PARKING
ASPHALT PARKING
ASPHALT PARKING
PROPOSED LIGHTING
TYP., RE CIVIL
PROPOSED WALK
PROPOSED
WALK
PROPOSED WALK
17'
PRIVATE
DRIVE
EXISTING UTILITY EASEMENT
TO BE REMOVED EXISTING WATER LINE
NEW CURB,
GUTTER, &
DRIVE
3' CHAIN LINK FENCE
FENCE SCREEN
PROPOSED STORM LINE
RE: CIVIL
PROPOSED
SANITARY LINE
RE: CIVIL
E
B
F
F
G
A
C
C
C
C
B
C
B
C
H
C
PROPOSED FIBER
OPTICS LINE
RE. CIVIL
PROPOSED WATER
LINE, RE: CIVIL
PROPOSED ELECTRIC
LINE, RE: CIVIL
PROPOSED UTILITY
EASEMENT RE: CIVIL
PROPOSED STORM LINE
RE: CIVIL
UTILITY
EASEMENT
BIOSWALE
PROPOSED WATER
LINE, RE: CIVIL
PROPOSED FIRE
WATER LINE, RE: CIVIL
PROPOSED ELEC
TRANSFORMERS,
RE: CIVIL
PROPOSED GAS LINE,
RE: CIVIL
9'
9'
PROPOSED STORM LINE
RE: CIVIL
PROPOSED WATER LINE
RE: CIVIL
PROPOSED GAS LINE
RE: CIVIL
PROPERTY BOUNDARY / R.O.W LIMITS OF WORK
PROPERTY
BOUNDARY / R.O.W
LIMITS OF WORK
PROPERTY
BOUNDARY / R.O.W
AMBULANCE
STORAGE
AMBULANCE CANOPY
(14'-0" CLEAR)
SPECIAL PAVING
A
G
C
C
B
F
C
C
E.1
PROPOSED
COURTYARD
EXISTING TREES TO BE
REMOVED OR RELOCATED
A
B
C
E F G H WALL
SIGN
DIRECTIONAL
SIGN
DIRECTORY SIGN
MAIN ID
MONUMENTS
1. TYPICAL HEAD TO HEAD PARKING STALLS ARE 9'x19'. WHERE VEHICLES OVERHANG LANDSCAPE, TYPICAL PARKING STALLS ARE
9'x 17'.
2. SITE IMPROVEMENTS AS NEEDED BY PHASE
NOTES
0 20' 40' 80'
BHA Design Incorporated
1603 Oakridge Drive
Fort Collins, Colorado 80525
voice: 970.223.7577
fax: 970.223.1827
LEGEND
SIGN KEY
MATCH LINE
PROPOSED TRANSIT STOP
PROPOSED TRANSIT STOP
INTERIOR COURTYARD
LAND USE DATA VICINITY MAP SCALE: 1''=1000'
GENERAL NOTES
LEGAL DESCRIPTION
1. Refer to Utility Plan for location of utilities and drainage facilities.
2. Developer shall ensure that the Landscape Plan is coordinated with the plans done
by other consultants so that the proposed grading, storm drainage, or other
construction does not conflict nor preclude installation and maintenance of
landscape elements.
3. Sidewalks and ramps shall be constructed in compliance with the Americans With
Disabilities Act. Handicap accessible routes shall slope no more than 1:20 in
direction of travel and no more than 1:48 cross slope.
4. The buildings will be equipped with an automatic fire extinguishing system meeting
the requirements of the Poudre Fire Authority.
5. Rooftop and ground-mounted mechanical equipment shall be totally screened from
public view from sidewalks and abutting streets.
6. Trash containers, trash compactors, pallet racks, and miscellaneous objects shall be
totally screened from public view.
7. Improvements as needed by phase.
8. Interior driveway radius shall be as required by local code.
A tract of land located in the Northeast Quarter of Section 4, Township 6 North, Range 68 West of the 6th Principal Meridian,
City of Fort Collins, County of Larimer, State of Colorado being more particularly described as follows:
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contained herein relative thereto:
COMMENCING at the North Quarter Corner of said Section 4; thence along the North line of the Northeast Quarter of Section
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the Point of Beginning
The above described tract of land contains 27.867 acres more or less and is subject to all easements and rights-of-way now on
record or existing.
0 50' 100' 200'
BHA Design Incorporated
1603 Oakridge Drive
Fort Collins, Colorado 80525
voice: 970.223.7577
fax: 970.223.1827
x EXISTING ZONING HARMONY CORRIDOR DISTRICT (H-C)
x PROPOSED LAND USE HOSPITAL / MEDICAL OFFICE BUILDING
x MAX. BUILDING HEIGHT PERMITTED SIX (6) STORIES
x MAX. BUILDING HEIGHT PROPOSED THREE (3) STORIES
x GROSS SITE AREA 27.867 AC.
x ESTIMATED FLOOR AREA 364,000 S.F. (8.356 AC.)
x FLOOR AREA RATIO 0.31
x PUBLIC ROW .941 AC.
x NET SITE AREA 26.926 AC.
SITE COVERAGE AREA PERCENT
BUILDING COVERAGE 206,487 S.F. 17.01%
DRIVES & PARKING 416,195 S.F. 34.29%
LANDSCAPE AREA AND WALKS (OPEN SPACE) 550,214 S.F. 45.33%
PUBLIC R.O.W. 40,990 S.F. 3.38%
ACTIVE RECREATIONS USE 0 S.F. 0%
TOTAL 1,213,886 S.F. 100%
PARKING ALLOWED PROVIDED
STANDARD PARKING: MEDICAL OFFICE (4.5/1,000 S.F.) 315
STANDARD PARKING: HEALTH FACILITIES - HOSPITALS 192+376
(1/BED + 1/TWO EMPLOYEES PER MAJOR SHIFT)
TOTAL COMBINED (SHARED) 883 765
ADA ACCESSIBLE PARKING (2% OF TOTAL) 36
TOTAL 883 765
BICYCLE PARKING REQUIRED PROVIDED
MEDICAL OFFICE (1/4,000 SQ. FT. 20% COVERED) 18 (4 COVERED) 18 (4 COVERED)
HEALTH FACILITIES (1/5,000 SQ. FT. 20% COVERED) 66 (14 COVERED) 66 (14 COVERED)
BANNER HEALTH
MEDICAL CAMPUS SITE
By: ______________________________________________
WITNESS my hand and official seal
________________________________
Notary Public
My commission expires: ___________________
City of Fort Collins
APPROVED BY THE DIRECTOR OF PLANNING OF THE CITY OF FORT COLLINS,
COLORADO ON THIS DAY OF ,A.D., 20
DIRECTOR OF PLANNING
DIRECTOR OF PLANNING
OWNERSHIP CERTIFICATION
The undersigned does/do hereby certify that we are the lawful owners of real property described on this site plan
and do hereby certify that we accept the conditions and restrictions set forth on said site plan.
The foregoing instrument was acknowledged before me this ________ day of ______________, __________,
by ____________________________ as _________________________ and ___________________________ as
___________________________________.
City Manager
By: ______________________________________________
City Attorney
Approved as to Form of Certification
By: ______________________________________________
City City Clerk
Attest
________________________________
Address