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• ' - <br /> . REQ1JtRED SUBMITTALS: � <br /> AQ of the infomtat�an must be submitted in or�ier for aur a licatian fo be rocessed: <br /> . �fitot . - <br /> , ���Enciosed � ��� �A� lcabie�� :.; :: -, <br /> C[ � Permif ica6on . . <br /> � CI P(an Review Fee <br /> [3 - � Pooi PEans <br /> C] 0 Surv lncludes radin tan <br /> � Q Hardcover Calculation INorksheets ' <br /> ❑ O Erosion Cont�ol Pian crou of MCWD Permit <br /> � 1� S �c em CerHf'�catioa <br /> t7 � WeBand Buffer Im rovemenf Pian <br /> Q 0 Esanw 8 Escfaw reement <br /> 0 � Other <br /> [J 0 Other . <br /> C7 ❑ �ther <br /> 0 p <br /> APPUCANT ACKNOWL�DGEMENT: <br /> • Aqreas Go provide adl infotmaGon required ar raqussted by the Pienning&Bur7ding Departrnerits; <br /> • Understands,if appilcable. an as-bWlt survey arid a�buUt t�rdcaover cov�sr ca�c�a�a�s,ere requ�ned#o be sub►nitEed aR�er tha <br /> prajed is oomplete(indtxfing finai gra�n9���P��9)P�to refun�ng the escro�++r; ' <br /> � Certifies that the IMomtador�su�pibd is true anrl correcx to the faest n�hfsther b�owle�e. The applicani�vognizes that they <br /> are solely responsibie for submiE�ng e camplete applicakon be�g aware that upon taiture to da sfl.the staff t�as�no�ltemati�re <br /> but ta reJect it unGf Et Fs�omptete; <br /> + Some ar aN of ti�e i�#orma�on that yau ar+�asked ta provide or►fhis�Ptic�ion is d�sifiec!by State law as�private or <br /> eonfidendaL Private da�a is infamTadon wh[ch ganeraAy cann�be give�,fo fhe publ'ic but can'be given to the subject of the data- <br /> Confident�data ls in�omta�on vifiidi gene.ra0y canns�k�give�fio e�her the pubitc ar the subject of the dara. O�u purposs and <br /> inte�dad use of this€nfor�ation is ta annyalty update our�and rec�rds of.other gavemmentat eger�ctes r�eq�red by law <br /> (f yau refuse to suppiy the b�formatia►,the penmit may not be iss�ed, <br /> L� --c�c.�T�NC��R.. <br /> Ap�Ncar�Ys Sigr�ature�: Dete: (\ ,,,�� <br /> ,L._ <br /> Owraee's Signature � . �ate: <br /> Pa�ket Rast Upda�eal:0�4/n4lt3 <br /> Page 20 of 21 <br />