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REQUiRED SUBMITTALS: <br /> All of the foflowing information must be submitted by the applicatior� deadline date in order for your <br /> application to be processed. <br /> Not <br /> Enclosed Applicable <br /> ❑ Vatiance A lication Fee <br /> ❑ Escrow reement si ned and Fee <br /> � ❑ Pre-A lication Form S�--C_ c Cti�.� r�t�s <br /> Varianc� kication Form <br /> ❑ Practical Difficulties Form <br /> 5�' � Certified Pro Owners List <br /> ❑ Surve meetin ALL re uirements <br /> "�K ❑ Pro sed Plans <br /> � ❑ Hardcover Calculations <br /> O Se tic S stem Site Evaluation Re rt <br /> ❑ Minnehaha Creek Watershed Distrid(MCWD) Pertnit or <br /> Documentation from MCWD statin no rmit is r ired <br /> � ❑ Ad'acent Pro Owners Acknowled ement <br /> 0 Data Priva Adviso Form <br /> APPLICANT ANDIOR OWNER: <br /> • Agree to provide all infonmation required or requested by the Planning Departrnent, <br /> • Agree to pay additional fees (staff time not covered in the arigiaal fee payment) arid/or consuttar�t expenses <br /> inCurred in review of this applicatio�, and <br /> • Certify that the ir�fomlation suppliad is true and correct to the b�st of his/her knowledge. The appllcant and <br /> ovrner recogniz�that they are sole�y r�sponsible for submitdng a complete appllcation betng awa,re <br /> that upon failure to do so, the staff has no alternative but to reject it untll it !s complete or to <br /> recommend the requsst for denial of the request r+egardless af its poter�tial merit. <br /> • Acknowle�ge the Escrow Agreement is completed and signed. <br /> • The�wner hereby adcnowledgss and agr�ees to this application and further authorizes reasonable entry or►to <br /> the property by City Staff, oor�sultartts, agents, Commisslon and Coundl �nbers for purposes of <br /> irnestiga�on and verification of this request. <br /> • Applicant anc�lor Owner acknowledge they must be present at all scheduled revlew meettngs of the <br /> Planning Commission and Council. If an applicant and/qr owner is unable to attend a scheduled meeting, <br /> please make arrangemerrts to have an author¢ed representative attend in place of the applicarrt/owr�er and <br /> advise tt�e City P{anner ass�gned to your project. <br /> Applicant's�ignature: Date: � � � p`�� �,� <br /> T� <br /> ApplicanYs Sign�ture: �Z-�� Date: ' <br /> T� <br /> Owne�s Signature: �� Date: t l� p� � <br /> /1 � <br /> Owner's Signature: l Date: 01 l 15 <br /> Paclaat Last Updeted: Auguffi 2015 F IE C E!V E D <br /> Pege 12 <br /> o�c � 5 za�� <br /> � � � o � crrv oF oRONo <br />