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City of Lake Elmo <br />DEVELOPMENT APPLICATION FORM <br />Fee $ 1061,60 <br />❑ Comprehensive Plan Amendment ❑ Variance T (See below) <br />❑ Zoning District Amendment <br />❑ Text Amendment <br />❑ Flood Plain C.U.P. <br />Conditional Use Permit <br />❑ Conditional Use Permit (C.U.P.) <br />APPLICANT: IVE-IL. gA.Ie4EA, <br />(Name) <br />❑ Minor Subdivision <br />Lot Line Adjustment <br />❑ Residential Subdivision <br />Sketch/Concept Plan <br />❑ Site & Building Plan Review <br />` +S-L 44V-,e Cu-KO 14UY AJ <br />(Mailing Address) <br />❑ Residential Subdivision <br />Preliminary/Final Plat <br />O 01-10 Lots <br />O I 1- 20 Lots <br />O 21 Lots or More <br />Q Excavating & Grading Permit <br />❑ Appeal <br />4, of <br />TELEPHONES: <br />(dome) (Work) (Mobile) (Fax) <br />Um <br />SS-0 ¢Z <br />(zip) <br />FEE OWNER: <br />(Name) (Mailing Address) (zip) <br />TELEPHONES: <br />(Home) (Work) (Mobile) (Fax) <br />PROPERTY LOCATION (Address and Complete (Long) Legal Description): 44SI L4vC G&Inc 4v= /U " <br />SECT- it Tvl°io-02q R"GE-az> <br />Pt EVZ--Sc/4- 9-cC.11 17-1Rzl <br />L-�OPUG A)LLJ OF cfL aFCup:PFnsT e)ciSl E-Lo AJw /z1uou,1 AF 43R® <br />DETAILED REASON- FOR REQUEST: Wc- WAA3s !o Ppcyioc A �'4`C-� F4-4 Aq�} R)< <br />Ct-wiSryK4s- TRee S4i-Es Avo Bee-,--, 4Rourvo )its <br />iA)aS-r 10e OF Ti{c /AEFC- 6,47eN i ti LL 144L/a 13e-rr�K 'Dg-44A14 c-- <br />'*VARIANCE REQUESTS: As outlined in Section 301,060 C. of the Lake Elmo Municipal Code, the Applicant must <br />demonstrate a hardship before a variance can be granted. The hardship related to this application is as follows: <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 further acknowledge the fee exulanation as <br />outlined in the anplication procedures and hereby agree to Dav all statements received from the City pertaining to <br />additional application expense. <br />a <br />Signature of Applicant ! Date Signature of Applicant Date <br />10/12003 City of Lake Elmo • 3800 Laverne Avenue North • Lake Elmo • 55042.65I-777-5510 • Fax 651-777-9615 <br />