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• <br /> = CITT OF MOUNDS V!EW <br /> PLA: IM ?1.ICATICN <br /> AFFUCANT: Phone 75 - 2G� <br /> ADDRESS: 6 � • <br /> /eZ) /4 -- //G <br /> Street Address, City, Stat-, and Zp Code <br /> • <br /> Interest in Property (check appropriate box): <br /> `- Owner of Property <br /> ❑ Contract for Deed Owner <br /> O Lessee, Operator, Manager <br /> ❑ Agreement to Purchase - <br /> ❑ Other (explain) <br /> • <br /> Documentary evidence of applicant's interest in the property may be required before final City action of this request <br /> PROPERTY INVOLVED: ���� <br /> Address/General Location X412-4 , (A <br /> Legal Description or Property Identification Number <br /> Legal Owner: Name/Address <br /> / <br /> Present Use (check appropriate box): <br /> ❑ <br /> UndevelopedNacant <br /> A., Single Family Dwelling • <br /> ❑ Duplex/Two Family Dwelling <br /> ❑ Multi-Family (No. of Units <br /> ❑ Business/Commercial Establishment <br /> ❑ Industrial Establishment <br /> ❑ Other (explain) <br /> Property Classification: Q Abstract Q Torrens <br /> REQUEST: g(-6/ _ ,Q-<": � .r <br /> *Please note: Applicant may be responsible for additional fees associated with the review of this requesr. <br /> I HEREBY DECLARE THAT THE ABOVE STATEMENT ARE TRUE. <br /> • Signature / k-- <br /> Rezoning 5200/acre.minimum$200.maximum x1,000 Park Fund Dedication Fee <br /> Variance R-1 to R-2-SS75, ail others$200 Date?aid <br /> c.anomonal use Perml) R-1 to R-2-$75, ail others$200 Receipt Number ; <br /> GJdE appeal <br /> $75 <br /> Develop./Site Plan Review 5100/acre,minimum 100,maximum $500 Total Fees Paid <br /> Minor Subdivision S150 Date Paid -=3 <br /> Major Subdivision 5250 Pius $250 deposit Receipt Number ✓�:�' ' <br /> Camp. Plan Amendment $200 <br /> Wetland Alteration Permit 550 plus deposit determined by Staff Additional Fee Paid <br /> Wetland Buffer Permit 310 Date Paid <br /> Planning Sign S50 Receipt Number <br /> PUD S350 <br /> PUO Amendment 5150 Date of final action <br /> APPROVED _ CENIED 1-7 <br /> Date // / '`-- Planning Case No. i Admin. Acccunt No. <br />