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, r � <br /> REQUIRED SUBMITTALS: � � <br /> All of the information must be submitted in order for your application to be processed: <br /> Not <br /> Enclos A `licab'!e � <br /> ❑ Permit A lication <br /> ❑ Plan Review Fee <br /> ❑ Pool Plans <br /> 0 Surve includes radin lan <br /> ❑ Hardcover Calculation Worksheets <br /> ❑ ❑ Erosion Control Plan or co of MCWD Permit <br /> O ❑ Se tic S stem Certification <br />� ❑ O Wetland Buffer Im rovement Plan <br /> O 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 /> • 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)prior to 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 <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: ,,._ Date: � �� `�� <br /> i <br /> Owner's Signature Date: ' <br />