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_ _______ _. <br />. <br />� <br />bi. .s�. �A � <br />c:,u�`u t��� <br />•j ',:` �;;�:;: �: ,,::�; <br />��J I>>:i�,�Li!�:�r <br />.� <br />"� �;� ; <br />. i:(s�;�cr, <br />A� ' � <br />ti <br />'Brist' PutoerSh�Q <br />COMMUNITY DE'VELOPMENT D�PARTMEN'r <br />DEVELOPMEI�IT APPLICATIC <br />2401 Highway 10, Mounds View MN 55112 <br />Please Type or Print Information - Complete Both Sides of This Form <br />612-717-4020 <br />612-784-3462 - FAX <br />AppGcant Information J � '/ ,,j <br />Nanne of Applicant �rN1 /iZ �2 �l�i l�L'4 � I -�- Telephone �'/z'��0`��� % <br />Address Z Z r/ �q�u/�o U' �1^ Fax <br />/�/1o�-�rd'S 1l, '-� r,c/ /YIl�/ � �/1 � _ <br />�erest in Property (check appropriate box) <br />Owner of Property ❑ Contract for Deed Owner <br />❑ Lessee, Operator, Manager o Agreement to Purchase <br />❑ Other (explain) ' <br />Applicants must provide evidence of interest in property at the time of application, and if you are not the owner of the <br />property, you must provide a letter of permission from the owner giving consent to the filing of this application. The <br />property ovmer must sign this application for it to be accepted. <br />Property Description/Proposal <br />Address or General Location <br />Legal Description <br />Property Identification # (PIN #) <br /># of Acres <br />Current Zoning <br />�� Z�� C�cr Tt Cl/OQ�7 �/^ <br />�% <br />Type of Application <br />o Comprehensive Plan Amendment <br />❑ Rezoning <br />❑ Major Subdivision <br />❑ Minor Subdivision <br />o Planned Unit Development (PUD) <br />❑ PUD Amendment <br />; -o.: __ Conditional Use Pernut <br />❑ Variance � <br />o Code Appeal <br />❑ Develop Review/Site Plan <br />o Wetland Alteration Pernut <br />❑ Wetland Buffer Pernut <br />❑ Floodplain Permit <br />❑ Other <br />$250 <br />$250/acre; min $250 max $1500 <br />$250 + $250 deposit* <br />$200 <br />Refer to rezoning fees <br />$350 - <br />R-1, R-2. $75; all others $250 <br />R-1, R-2 $ T00 all others $250 <br />$100 <br />$125/acre; min $125 max $750 <br />R-1, R-2 $150; all others $200 <br />R- l, R-2 $25; all others � 100 <br />$200 <br />*Deposits shall be paid to cover all costs of public notices, materials and staff or consultant time spent in the review, <br />research or preparation of materials associated with this application. The applicant shall be responsible for all reasonable <br />incurred costs in excess of the initial deposit amount. Any portion of the deposit not spent or encumbered shall be refunded <br />to the applicant within thirty (30) days after consideration of the application is completed. <br />Please complete the reverse side of this application. <br />