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`�;`�` ,��, <br />�''I �;�':r�(���. CC) ���I,OPI��dT I)E�r�it NT <br />`� Il��IJ�PMEI��' r��'PI�ICA`I'I��d <br />" �":�''`'''``= 240� I-�a�hway 10, Mounds View MN 55112 <br />.. . i"a ,fiUr <br />��,o ' �::a � <br />ro��tt ° Parrnats'��Q' C�Z-%1%-4OZO <br />612-784�3462 � FAX <br />Please 'Fyp� or �eti�t lnformatio�t - CoQnple�e ��th Sades o€'Tl�i� Fortn <br />AppLicaa# I��°oa��tgon l / <br />Naane of Appiicant Gf� � d' � Telephone (9�L `%� Q- 3`� `�� <br />Address � l_3 �� a:e Qc/lP�t/ P�2c�c.2� Fax <br />d U'w� 1(/ � �/+�/ <br />In4erest in �roperty (cheok appeopriatc box} <br />� Owner of Property [� Contract for Deed Owner <br />a Lessee, Operator, Manflger ❑ Agreeenent to Pwchase <br />Q Other (explain) <br />Applicants �atsi prowide evidence a►f interesi in pa�operty at the tim� af a�ap[acatio�sy a�ci �i'yoea are not the orva�ee of the <br />peaperty, you mus� provdde a letie� of per�aissi�n frors� the oevnea giving co�seni to the �°rling of this appl�cation. Tt►e <br />ps�aperty o�er must sign tbis applicatioo �or it to be accepted. <br />�a•oPea�ty IDescription/Proposat <br />Address or General Location <br />Legai Description <br />Properiy Identificatioa # (PIN #) <br /># of Acres <br />Current Zoning <br />b'7 -30 -�3-l3� ofl5(o-y <br />Type of Application <br />❑ Coznprehensive Plan Amendment <br />❑ Rezoning <br />a Major Subdivision <br />❑ Minor Subdivision <br />❑ Planned UniC DevelopmenE (PUD) <br />�7 PUD Amendment <br />a Condi€ional Use Peruut <br />Variance ' <br />a Code Appeal <br />❑ DeveEop Review/Site Plan <br />Q Wetland Alterafion Pertnit <br />� Wetiand But%e Permit <br />Q Floodp{ain Permit <br />❑ Other <br />�250 <br />$250/acre; min $25fl max $ i 500 <br />$250 + $Z50 deposit* <br />$zoa <br />Refer to rezoning fees <br />$350 <br />R-1, R-2 $75; QiI others �250 <br />R-1, R-2 $1 OO a110the�s $250 <br />�100 <br />$125/acre; min $1 �S raa.c $750 <br />R- !, R-2 � 1 S0; all others �Z00 <br />iZ-!, R-2 $25; ail others $(00 <br />$200 <br />�DeposiEs shalt be p�id to cover a[1 costs of pubitc notices, materials and staf� or consultant time spent in the review, <br />research or preparation of materiats associated widi this applicatian. 'i'he applicnnt shafl be responsible for all reasonable <br />incurred costs in excess oF the initial deposit amount. /�ny portion of the deposiE not spent or encumbered shakl be re�unded <br />to the appficant withir► ihirty (;0) days atter consideration ox the appiication is completed. <br />�Icase co�plete the reverse side af this ag�pdi�ateone <br />