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REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed A licable <br /> ❑ Buildin Permit Escrow A reement and Fees <br /> � ❑ Plan Review Fee <br /> ❑ Com leted Ap lication Form <br /> ❑ Pro osed Pool or Hot Tub Plans—2 sets, full-size, to scale <br /> ❑ Surve —2 full size, to scale(meetin ALL surve requirements) <br /> ❑ Hardcover Information <br /> ❑ ❑ Septic S stem Certification <br /> ❑ ❑ Minnehaha Creek Watershed District(MCWD) Permit or <br /> documentation from MCWD statin no permit is re uired <br /> ❑ ❑ Landsca e Walls and/or Retainin Wall Plans <br /> 0 ❑ Stormwater Pollution Prevention Plan <br /> ❑ ❑ Data Privac Adviso Form <br /> ❑ ❑ <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Planning&Building Departments; <br /> • Understands, if applicable, an as-built survey and as-built hardcover cover calculations, are required to be submitted after the <br /> project is complete(including final grading and landscaping)prior to refunding the escrow; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are <br /> solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative but to <br /> reject it until it is complete; <br /> • Some or all of the information that you are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. <br /> Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this information is to annually update our records and records of other governmental agencies required by law. If <br /> you refuse to supply the information,the permit may not be issued. <br /> ApplicanYsSignature: � ,,�'�� Date: / �-` �� �/ � <br /> Owner's Signature Date: <br /> .o JOHN CIHUlVKA <br /> �psp BRANCH MANAGER <br /> rhe A_�,<,<����o�o� johnc@valleypools.com <br /> ..�i 3 So=�����e_s a.��� <br /> ,� ��� �� & s� <br /> � "The Way[o Relnx Sinee 1974" <br /> www.valleypools.com <br /> C — � 1Z--��3 �c�4,�7;� <br /> 3426 Bunker Lake Blvd.NW (763)576-0762 Ext.105 <br /> Andover,MN 55304 Fax:(763)576-0789 <br /> Packet Last Updated: Apri!2016 <br /> Page 23 <br />