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.
• If required, I will provide the required neighborhood notification information to abutting property owners 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 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 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 understand that the subject application will not be considered completed until the Property Owner of record completes and submits the Property Owner Certification Statement, available at https://mansfield-planningdevelopment-mansfield-ct.app.transform.civicplus.com/forms/13620.