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<br /> gys TAPPLICANT. ache - .fit m . a } * on $O-�� •a
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<br /> . DDRESS 5505 n ^ 1' 2 i "�5' Ty ~j xs,
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<br /> Interest In Property (check appropriate-box) y ,wrf -4 - ,-,A - 1, " r.- may "
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<br /> -�-} .0„t...-*-.- F.,•'4 1'.` '/:Wilt .:. +'._�°- �:.� �' �
<br /> '�� Ownerof Property"' `_ _
<br /> ❑ Contract_ for Deed Owner T _, .,„ z
<br /> . Q Lessee, Operator';Manager '- � ` ? c; x
<br /> Q -......,.A r_eement to Purchase ..° _._ -' qt. 7/.
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<br /> Documentary evidence of applicant's interest in the property may be required before final City action of thea.request 'v,,
<br /> PROPERTY-INVOtLVED� � ._ . r r • y1. ,al � st;,.. 14,= 2
<br /> 4 " "Address/General LocationSnS-CJa�n-y -4. QuD ( n Iea .
<br /> Legal Description or Property Identification Number .So. 5-� (a 1 /1 1..c T XeLi,4
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<br /> Legal Owner: Name/Address /J1TC -7/iLinJ72x-Al 5771-7E5 /PI& .-GF... 1- S mud..
<br /> / q5Z) 4- 0 k 7ci A. SCA/a- -
<br /> Present Use (check appropriate box) =
<br /> • ❑ UndevelopedNacant
<br /> Single Family Dwelling ;
<br /> ❑ Duplex/Two Family Dwelling
<br /> ❑ • Multi-Family (No. of Units -_• : ) t '
<br /> •
<br /> ❑ Business/Commercial Establishment •
<br /> ❑ Industrial Establishment
<br /> ❑ Other (explain)
<br /> Property Classification: 0 Abstract 0 Torrens _.
<br /> REQp�EST: %G3�. /�Xo1E'� 'iliiir< ycA• // /Q7,- L, .. 4.. — -- , 7 . , � C ,.
<br /> Mitt- O4
<br /> •
<br /> *Please note: Applicant may be responsible for additional fees associated with he review of this r-•ues
<br /> I HEREBY DECLARE THAT THE ABOVE STATEMENT ARE TRUE. d
<br /> Signa ure
<br /> ********************************************************************************************
<br /> Rezonin• $200/acre, minimum ' •0,maximum $1,000 Park Fund Dedication Fee
<br /> -gale-•fie --1 to R-2-S75.all others$200 Date Paid
<br /> - • on- ■s-- Permi --1 to R-2-$75,all others$200 Receipt Number
<br /> ode appeal $75
<br /> Develop./Site Plan Review $100/acre,minimum 100,maximum $500 Total Fees Paid 0 • al'
<br /> Minor Subdivision $150 Date Paid - -Q
<br /> Major Subdivision $250 plus $250 deposit Receipt Number t2C --
<br /> Comp. Plan Amendment $200
<br /> Wetland Alteration Permit $50 plus deposit determined by Staff Additional Fee Paid
<br /> Wetland Buffer Permit $10 Date Paid
<br /> Planning Sign $50 Receipt Number
<br /> PUD $350
<br /> PUD Amendment $150 Date of final action
<br /> APPROVED 0 DENIED ❑ TABLED 0
<br /> c- - -) - 0 ir- .,. ., 2 0 -1 - ALL- .-I • •--_.._. .,_ ._ ,/4
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