2013-00803/04-voided - Laserfiche WebLink

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REQUIRED SUBMITTALS: � � ' � All of the information must be submitted in order for your application to be processed: Not Enclosed Applicable ❑ Permit A lication ❑ Plan Review Fee ❑ Pool Plans ❑ Surve includes radin lan ❑ ❑ Hardcover Calculation Worksheets ❑ ❑ Erosion Control Plan or co of MCWD Permit ❑ ❑ Se tic S stem Certification ❑ ❑ Wetland Buffer fmprovement Plan ❑ ❑ Escrow & Escrow A reement ❑ ❑ : Other ❑ ❑ Other ❑ ❑ Other ❑ ❑ APPLICANT ACKNOWLEDGEMENT: • Agrees to provide all information required or requested by the Planning & Building Departments; • Understands, if applicable, an as-built survey and as-built hardcover cover calculations, are required to be submitted after the project is complete (including final grading and landscaping) prior to refunding the escrow; • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are solely responsible for submitting a complete 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 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 permit may not be issued. � �� `� Applicant's Signature: z--- Date: � L /� Owner's Signature Date: � /� ' J Packet Last Updated: 03/04/13 Page 20 of 21