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REQUIRED SUBMITTALS: r-All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed Applicable <br /> ❑ 0 Permit Application <br /> ❑ 0 Plan Review Fee <br /> ❑ 0 Pool Plans <br /> ❑ ❑ Survey(includes grading plan) <br /> ❑ 0 Hardcover Calculation Worksheets <br /> ❑ 0 Erosion Control Plan or copy of MCWD Permit <br /> ❑ ❑ Septic System Certification <br /> ❑ 0 Wetland Buffer Improvement Plan <br /> ❑ 0 Escrow& Escrow Agreement <br /> ❑ 0 Other <br /> ❑ 0 Other <br /> ❑ 0 Other <br /> ❑ 0 <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Planning &Building Departments; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to 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. <br /> If you refuse to supply the information,the permit may not be issued. <br /> Applicant's Signature: r..,�. A. . Date: <br /> V <br /> 2s / <br /> Owner's Signature � � Date: / <br />