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� � t�€CEiVED <br /> REQUIRED SUBMITTALS: �JUI�� O� �0�5 <br /> All of the following information must be submitted by the application deadline date in ord�r foryQtlfO� <br /> application to be processed. Gi11f OF oR <br /> � Not <br /> Enclased Applicable <br /> ❑ Variance A licafion Fee <br /> 6scraw A er�t s ned.�nd ee � <br /> ❑ P�e-A lication Form <br /> ❑ Vsnance liCabion FoRn ' <br /> ❑ ❑ Practical Qifficulties Form <br /> ❑ Cerf�ied I�ro .s OvDner� List <br /> � Surve meetin ALL re uirements <br /> ❑ Pro Qsed �'lan� . � <br /> � Hardcover Calculations <br /> ❑ Se fic S stem S�te�valuaticin Re ort <br /> � � Minnehaha Creek Watershed District (MCWD) Permit or <br /> Documentation from MCWD statin no ermit is re uired <br /> C3 Ad'acent Pro �a Ow�ers Ar,lcnowled ement <br /> ❑ Data Privac Adviso Form <br /> APPLICANT ANDlOR OWNER: <br /> • Agree to provide all information required or requested by the Planning Department, <br /> . Agree to pay additional fees {staff time not covered in the original fee payment) anrf/or consultant expenses <br /> incurred in review of this application,artd <br /> . Certify that the ir�farmation supplied is true and correct to the best of hislher knowledge. 7he appllcant and <br /> owner recognize that they are solely responslble for submltting a complete application being aware <br /> that upon fallure to do so, the staff has no alternative but to reJect ft until it is camplete or to <br /> recommend the request for denial af the request regardless of its poterrtial merit, <br /> • Acknowledge the Escrow Agreement is completed and signed. <br /> • The Ovmer hereby acknowledges and ag�ees to this applicatiQn and further autho�izes reasonable entry onto <br /> the property by City Staff, consuftants, agents, Commission and Council Members for purposes of <br /> in�estigation and verificafion of this request. <br /> • Applicant andlor Owner acknowledge they must be present at all scheduled rev�ew meetings of the <br /> Planning Commission and Councll. If an applicant and/or owner is unable to attend a scheduled meeting, <br /> please make amangements to have an authorized representative attend in place of the applicantlowner and <br /> advise the City Planner assigned to yaur project. <br /> App�icanYs Signature: ate: /J,,�,/�$� <br /> ApplicanYs Signature: Data: <br /> Owners Signature: /�,j�}- Date: <br /> Owner's Signature: Date: <br /> Pecket Last Updeted.• Jarruary 20t5 <br /> Page 12 <br /> � � �` �3 <br />