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Apr 2011 09:47a Pelican Bay Pack & Ship 939-325-8534 p.3 REQUIRED SUBMITTALS: Ali of the following information must be submitted by the application application to be processed. deadline date in order r your Enclosed ❑ © 0 Not able Applicable ❑ ❑ ❑ Escrow Agreement signed Escrow received Pre -Application Form ❑APplication Form ❑ ❑ Hardship Documentation L7 ❑I Certified Proa Owners List 0 Survey meetin ALL requirements shown on P@ges 5 - 6 © 0 P ed Plans ❑ ® Hardcover Calculation(s) ❑ 0 Septic S em She Evaluation: Report 0 Wetland Delineation E3 Wetland Buffer Evaluation 0 M Buffer Improvement Plan 0 p APPLICANT ANDVOR OWNER: Agree to provide all information required or requested by the Planning Department, Agree to pay additional fees (staff time not covered in the original fee payment) and/or consultant expenses incurred in review of this application, and Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner recognize that they are solely responsible for submitting a complete application being aware that upon lallure to do so, the staff has no alternative but to rgject it until it is complete or to recommend the request for denial of the request regardless of Its potential merit. Acknowledge the Escrow Agreement is completed and signed. The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification of this request. Applicant and/or Owner acknowledge they must be present at all scheduled review meetings of the Planning Commission and Council. If an applicant and/or owner is unable to attend a scheduled meeting, please make arrangements to have an authorized representative attend in place of the applicant/owner and advise the City Planner assigned to your project. Some or all of the information that you are asked to provide on this application is classified by State law as either private or confidential. Private data is Information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. if you refuse to supply the information, the application may not be issued. Applicant's Signature: D Dam: 6 r a / Applicant's Signature. �.,� Date: Owner's Signature: Date: Owner's Signature: Date: -14- a