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City of Lake Elmo <br />DEVELOPMENT APPLICATION FORM <br />r ee "h--1 . <br />❑ Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />❑ Flood Plain C.U.P. <br />Conditional Use Permit <br />❑ ConditionaI Use Permit (C.U.P.) <br />APPLICANT: =lam —' � , 19 <br />(Name) <br />TELEPHONES: is.11C - .3yr' = <br />❑ Variance * (See below) <br />❑ Minor Subdivision <br />Lot Line Adjustment <br />❑ Residential Subdivision <br />Sketch/Concept Plan <br />❑ Site & Building Plan Review <br />(Mailing Address) <br />❑ Residential Subdivision <br />Preliminary/Final Plat <br />O Oi —10 Lots <br />O 11— 20 Lots <br />O 21 Lots or More <br />�a�a�ir�g`�c"C°�r�ding3'ermit z <br />❑ Appeal <br />(Mobile) (Fax) <br />ism <br />(zip) <br />FEE OWNER: <br />(Name) (Mailing Address) (Zip) <br />TELEPHONES: <br />(Work) (Mobile) (Fax) <br />PROPERTY LOCATION (Address and Complete (Long) Legal Description): 5;��J;7 le, 7: /6 <br />�prd ,�27 TZz-ryas' Cao - p -t rZ SG '% - cP7a9'-:4a' <br />"7-Z& Pi - <br />DETAILED REASON FOR REQUEST: '% 150- <br />✓,& •✓E Gt A-57, zr-�D / 7iiE IVA) &ezo:. ei. 6n 727,47- <br />2` <br />07 za cf-zly Og7- UPI A Aug W AAO <br />t, -,yA " � A-e &)_T"L0u` AKSC Me-= i 16 u��Tez corC sfo-1 pe css) Pf-Ag at <br />'*VARIAN.CE,R'EdHESTS: As outlined in Section 301.060 C. of the Lake Elmo Municipal Code, the Applicant must <br />`.deinonsirata a hardship before a variance can be granted. The hardship related to this application is as follows: <br />Ccsfiri: av :+�� f,4f✓o k%-r vEsr pc,o �er� `f,, <br />/.r�-7c'€. fie12 c�ov e2r�✓ �' �l es r�-ty+.—. <'e�ysr�✓nez�- <br />&la Av z' 9 c..i..S <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the <br />Zoning and Subdivision Ordinances and current administrative procedures. I farther acknowledge the fee explanation as <br />outlined in the anplication procedures and hereby agree to pay all statements received from the City pertaining to <br />additional application expense. <br />( -6 <br />S ature of Applicant Date Signature of Applicant Date <br />10/12003 City of Lake Elmo • 3900 Laveme Avenue North • Lake Elmo • 55042. 651-777-5510 • Fax 651-777-9615 <br />