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� � ` ' <br /> . <br /> Y�4d4,�1t'S�D S�l/Bt�t�l I IFILJ: <br /> ��'r�f the infarmation must be submitted in order for your application to be processed: <br /> r--- I�lo# <br /> Enclosed A licahle <br /> ❑ � Buiidin Permit Escrow A reement and Fees <br /> ❑ ❑ Plan Review Fee <br /> � ❑ Com leted A tication Form <br /> ❑ ❑ P�o osed Pool or Hot Tub Plans—2 sets, full-size, to scale <br /> ❑ ❑ Surve —2 full size, to scale meetin ALL surve re uirements <br /> ❑ ❑ Hardcover Information <br /> � ❑ Se tic S stem Certification <br /> ❑ ❑ Minnehaha Greek Wa#ershed District (MCWD) Permit or <br /> documenfatian from MCWD statin no ermit is re uired <br /> ❑ ❑ Landsca e Walls andlor Retainin Wall Plans <br /> ❑ ❑ Stormwater Pollution Prevention Plan <br /> ❑ ❑ Data Privac Advisor Form <br /> ❑ ❑ <br /> APPLIGANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Planning&Building Departments; <br /> • Understands, if applicable, an as-built survey and as-built hardcover cover calculations, are required to be submitted after the <br /> project is complete( including final grading and landscaping)priorto refunding the escrow; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are <br /> solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternafive but to <br /> reject it until it is complete; <br /> • Some or all of the infarmation 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 cannat be given to eitherthe public orthe subject ofthe data. Our purpose and <br /> 1 intended use of this information is to annually update our records and records of other governmental agencies required by law. If <br /> { you refuse to supply the information, ermit may not be issued. <br /> i <br /> b-c�,i�--�—�� <br /> �Signature: Date: � � �' <br /> ��,� . � <br /> Owne�s Signature � �/ Date: �'�� �� � <br /> � <br /> �G� �� �� <br /> ?acket Last Updated: August 20 i5 <br /> Page 23 <br />