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<br /> REQUIRED SUBMITTALS:
<br /> All of the following information must be submitted by the application deadline date in order for your
<br /> application to be processed.
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<br /> ❑ Escrow A reement si ned
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<br /> � ❑ Pre-A (ication Form
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<br /> ❑ Practical Difficulties Documentation
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<br /> ❑ Surve meetin ALL re uirements shown on a es 5-6
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<br /> . ❑ Hardcover Calcutation s
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<br /> ❑ Wetland Delineation
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<br /> ❑ Buffer Im rovement Pfan
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<br /> APPLICANT AND/OR OWNER:
<br /> • Agree to provide all information required or requested by the Pfanning Department,
<br /> • Agree to pay additional fees (staff time not covered in the original fee payment) and/or consultant expenses
<br /> incurred in review of this application, and �
<br /> • Certify that the information supplied is true and correct to the best of his/her knowledge. The appficant and
<br /> owner recognize that they are solely responsible for submitting a complete application being aware
<br /> that upon faifure to do so, the staff has no alternative but to reject it untif it is complete or to
<br /> recommend the request for denial of the request regardless of its potential meri�
<br /> • Acknowledge the Escrow Agreement is completed and signed.
<br /> • The Owner hereby acknowledges and agrees to this app(ication and further authorizes reasonable entry onto
<br /> the property by City StafF, consultants, agents, Commission and Council Members for purposes of
<br /> investigation and verificafion of this request.
<br /> • Applicant and/or Owner acknowledge they must be present at all scheduled review meetings of the
<br /> Planning Commission and Council. If an applicant and/or owner is unable to attend a scheduled mee6ng,
<br /> please make arrangements to have an authorized representafive attend in place of the applicanUowner and
<br /> advise the City Planner assigned to your project.
<br /> • Some or all of the informafion that you are asked to provide on this application is class�ed by State law as
<br /> either private or confidential. Private data is information which generally cannot be given to the public but can
<br /> be given to the subject of the data. Co�dential data is information which generaffy cannot be given to either
<br /> the public or the subject of the data. Our purpose and intended use of this information is to annually updafe
<br /> our records and records of other govemmental agencies required by law. If you refuse to supply the
<br /> information,the application may not be issued.
<br /> Applicant's Signature: �_ Date: Z Zo (
<br /> Applicant's Signature: Date:
<br /> �_ ��'Z r �2.o r�
<br /> Owner's Signature:� ��/�,. '� te:
<br /> .�r—��y-s
<br /> � Owner's Signature: Date:
<br /> - 13- �ECi��V��
<br /> • SEP 2. 1 2011
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<br /> CtTY OF OROI�lO . �
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