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� REQUIRED SUBMITTAL�: Ail of the infiormation must be submit�ed in order for your application to be processed: Not Enclosed � A licable ❑ i ❑ Permit A lication ' ❑ G Plan Review Fee ❑ ❑ ; Pool Plans ❑ � Surve (includes radin plan) i ❑ ❑ Hardcover Calculation Worksheets ❑ ❑ � Erosion Control Plan or co of MCUVD Permit ❑ � Septic S stem Certification ❑ ❑ Wetland Buffer Improvement Plan i ❑ � Escrow & Escrow A reement ❑ � ❑ � Other ❑ ' ❑ � Other � ❑ '� L� ; Other �i � ❑ i 0 i i APPLICANT ACKNOWLEDGEMENT: i • Agrees to provide ali information required or requested by the Pianning&Building Departments; i I • Understands. if applicable. an as-built survey and as-built hardcover cover calculations, are required to be submitted after the � I project is compiete(including final grading and landscaping) prior to refunding the escrow; � j Certifies that the information suppiied is true and correct to the best of his/her knowiedge. The applicant recognizes that they � • are solely responsible for submitting a compfete application being aware that upon failure to do so, the staff has no alternative � but to reject it until it is complete: , • Some or all of the information that you are asked to provide on this application is classified by State law as either private or I � confidential. Private data is information which generafiy cannot be given to the public but can be given to the subject of the data. � Corfidential data is information which generaliy 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 permit may not be issued. i r Appiicants Signature: � �aie: lo� I%/ 1 �� Owner's Signature /��"" Date: �^ � �� ( , Packet Last Updated. 03/04/13 Page 20 of 21