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REQUIRED SUBMITTALS: r� <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclosed Applicable <br /> � ❑ Permit Application <br /> � ❑ Plan Review Fee <br /> ❑ Pool Plans <br /> p ❑ Surve includes radin plan <br /> ❑ � Hardcover Calculation Worksheets <br /> ❑ Erosion Control Plan or cop of MCWD Permit <br /> ❑ Septic S stem Certification <br /> ❑ Wetland Buffer Improvement Plan <br /> ❑ ❑ Escrow& Escrow A reement <br /> ❑ ❑ Other <br /> ❑ ❑ Other <br /> ❑ ❑ Other <br /> ❑ ❑ <br /> APPLICANT ACKNOWLEDGEMENT: <br /> . Agrees to provide all information required or requested by the Planning &Building Departments; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to reject it until it is complete; <br /> • Some or all of the information that you are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. <br /> Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this information is to annually update our records and records of other governmental agencies required by law. <br /> If you refuse to supply the information,the permit may not be issued. <br /> ApplicanYs Signature: „� r Date: F'/ 1 �� Z <br /> �J � <br /> Owner's Signature Date: <br />