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City of Mounds View,MN <br /> Development Application Page 2 <br /> Present Use of Property <br /> ❑ Undeveloped/Vacant ffi Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling ❑ Multi-family Dwelling <br /> ❑ Business/Commercial Establishment ❑ Industrial Establishment <br /> ❑ Other(explain) <br /> Property Classification ❑ Abstract nt Torrens <br /> Description of Proposal To subdiviap the property in to two lots. One with <br /> tha axi et inrj ho»ea and nnP fnr aPVP1 npmPnt <br /> BY MY(OUR)SIGNATURE ON THIS APPLICATION,I HEREBY DECLARE THAT,TO THE BEST OF MY <br /> KNOWLEDGE,THE INFORMATION PROVIDED IS TRUE AND ACCURATE. <br /> Signature of Applicant <br /> Name of Applicant(typed/printed) T)TTANE V. PETERSON — NCY PETERSON <br /> Signature of Property Owner i i , . <br /> Name of Property Owner(typed/printed) nnANR R. PETERSON — ANCY •ETERSON <br /> Address of Owner ,81Q5 MA n T S QN ST_ N_E_ <br /> TSANTT . MTNNESOTA 55040 <br /> Phone Number of Owner (61 2) 444-646R <br /> ************************************************************************************************ <br /> Date of Submittal ‘-i-20 —6'1r^ FOR OFFICE USE ONLY <br /> Date of Acceptance Assigned to: <br /> Planning Case No. S — 9 g 60-day Limit 120-day limit <br /> Fees Paid: Account# Check# Receipt# • <br /> Application: vZ/j() do f)) 7 <br /> Park Dedication: <br /> Deposits: <br /> Other. <br /> Total: <br /> N:\DATAZROt1Ps\COMDEV\FORMS\DEVAPP.FOR 1/98 <br />