In authorizing the submission of this application, I hereby certify the following:

• The agent identified herein is authorized to act on my behalf regarding this application.
• I am familiar with the information contained in the application submissions and that such information is complete,true and correct to the best of my knowledge.
• I will provide the required neighborhood notification information to abutting property owners by certified mail within seven (7) days of Commission receipt of the application and will provide the required documentation of said notice to the Department of Planning and Development prior to issuance of a decision.
• I will send the required notices (if applicable) to the Department of Public Health and applicable water company/water supply system within 7 days of Commission receipt of the application and provide documentation of said notice to the Department of Planning and Development prior to issuance of a decision.
• I understand the penalties for obtaining a permit through deception or through inaccurate or misleading information.
• I understand that the subject application must comply with all applicable requirements of the Mansfield Zoning Regulations.
• I acknowledge that should the PZC determine that professional and/or technical assistance is needed for review of the application, the cost of such services shall be my responsibility pursuant to Chapter 122, Article V of the Mansfield Code of Ordinances. Furthermore, I understand that the consultants retained shall be selected by and report directly to the Planning and Zoning Commission and that no application review shall commence until the required deposit for such services has been provided. I further acknowledge that failure to pay the estimated cost of the review within five (5) days of notice from the Town may be used as justification to deny the application as incomplete.