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1 1 i.fi ;"'D COMMUNITY DEVELOPMENT DEPARTMENT <br /> DEVELOPMENT APPLICATION <br /> 2401 Highway 10, Mounds View MN 55112 <br /> -Pa.rm ° 612-784-3055 <br /> 612-784-3462 -FAX <br /> Please Type or Print Information-Complete Both Sides of This Form <br /> Applicant Information <br /> Name ofApplicant C h ,c , �, C L e:�-� Telephone q (a - 7"7 7/ <br /> Address ` `. °OUYI Fax l 0 4 Co - aCQ <br /> - -- ►ai <br /> Interest in Property(check appropriate box) <br /> O Owner of Property <br /> O Contact for Deed Owner <br /> Lessee,Operator,Manager <br /> a Agreement to Purchase <br /> a 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 /> ipoperty owner must sign this application for it to be accepted. <br /> Property Description/Proposal <br /> Address or General Location 3 q t/ Eats,[,cine <br /> Legal Description <br /> • Property Identification#(PIN#) <br /> #of Acres <br /> Current Zoning —.3 <br /> Present Use Type of Application <br /> a Undeveloped/Vacant a Comprehensive Plan amendment S200 <br /> a Single Family Dwelling a Rezoning 5200/ac,min 5200 max 51000 <br /> C DupiexiTwo Family Dwelling C Major Subdivision 5250 5250 deposit* <br /> v1+fuid-(trolly Dwellings a Naar Subdivision 5150 <br /> Business/Commercial Establishment C Planned Unit Development(PUD) 5350 <br /> a Industrial Establishment -- a PUD Amendment 5150 <br /> • Other(explain) . Conditional Use Permit R-I,R-2 S75;aII otiiax <br /> a Variance R-1„R-2 S75;all others 5200 <br /> a Code Appeal 575 <br /> a Develop Review/Site Plan S 100/ac;min 5100 max 5500 <br /> a Wetland Alteration Permit 550+deposit* <br /> a Wetland Binet Pe mit 7 <br /> a Floodplain Permit 5200 <br /> • C Other <br /> 'see Municipal Code for explanation of deposits <br /> Please complete the reverse side of this application. <br />