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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 lication 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 SA.T1-}2E—6t 6lUlST
<br /> °�` i "� ' �a4':p' ,F� Pro�osed;'Plaris:� � t, > �'" �' ;� �
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<br /> � Hardcover Calculation s
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<br /> �❑ Wetland Delineation Sva b�DA
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<br /> ❑ ❑ Buffer Im rovement Plan o� D,4
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<br /> APPLICANT AND/OR 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) 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 applicant and
<br /> owner recognize that they are solely responsible for submitting a complete application being aware
<br /> that upon failure to do so, the staff has no alternative but to reject it until it is complete or to
<br /> recommend the request for denial of the request regardless of its potential merit.
<br /> • Acknowledge the Escrow Agreement is completed and signed.
<br /> • The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto
<br /> the property by City Staff, consultants, agents, Commission and Council Members for purposes of
<br /> investigation and verification 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 meeting,
<br /> please make arrangements to have an authorized representative attend in place of the applicant/owner and
<br /> advise the City Planner assigned to your project.
<br /> • Some or all of the information that you are asked to provide on this application is classified 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. Confidential data is information which generally 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 update
<br /> our records and records of other governmental agencies required by law. If you refuse to supply the
<br /> information,the application may not be issued.
<br /> Applicant's Signature: ��_,— ��� Date: _/Z- l3 - Zol.(
<br /> Applicant's Signature: Date:
<br /> Owner's Signature: ��--����Date: 1Z• �3 • ��\
<br /> Owner's Signature: Date:
<br /> RIECEIVED
<br /> - �3- JAN 1.8 2Q12 �
<br /> C��OF ORONO
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