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CITY OF MOUNDS VIEW <br /> PLANNING APPLICATION <br /> AFFUCANT: :/ ,° � ,� h Phone ; /� /(;, <br /> ADDRESS: /1/ "'", //1/ .0 �J C?‘:,/1*2 Z(le) <br /> Street Address, City, State, and Zip Cade 3' .. I <br /> Interest in Property (check appropriate box): <br /> Owner of Property <br /> ❑ Contract far Deed Owner <br /> ❑ Lessee, Operator, Manager <br /> ❑ Agreement to Purchase <br /> • Other (explain) <br /> Documentary evidence of applicant's interest in the property may be required before final City action of this request. <br /> PsOPEaT-YINVOLVED:- - -Address/General Location <br /> Legal Description or Property Identification Number (""'d.- <br /> Legal <br /> ""'.i-Legal Owner:flame/Address i , C To Y� G >�d c<) r C <br /> S/ 6- — o 0 d )V 4/.,z/, BJP <br /> Present Use (check appropriate box): <br /> ❑ UndevelopedNacant <br /> • Single Family Dwelling <br /> • ❑ Duplex/Two Family Dwelling <br /> ❑ Multi-Family (No. of Units ) <br /> • <br /> ❑ Business/Commercial Establishment <br /> ❑ Industrial Establishment <br /> ❑ Other (explain) <br /> Property Classification: 0 Abstract Torrens <br /> REQUEST: /7)� C <br /> 'Please note: Applicant may be responsible for additional fees associated h e review of this request. <br /> I HERESY DECLARE THAT THE ABOVE STATEMENT ARE TRUE./ <br /> v Signature <br /> Rezoning 5200/acre,minimum $200.maximum $1,000 Park Fund Dedication Fee <br /> Variance R-1 to R-2-$75,all others $200 Date Paid <br /> Conditional Use Perm R-1 to R-2-$75,all others$200 Receipt Number <br /> Code Appeal S75 <br /> Oevelop./Site Plan Review S100/acre,minimum 100.maximum $500 Total Fees Paid '75;00 <br /> Minor Subdivision S150 Date Paid <br /> Major Subdivision $250 plus$250 deposit Receipt Number zi30 <br /> Comp. Plan Amendment $200 <br /> Wetland Alteration Permit S50 plus deposit determined by Staff Additional Fee Paid <br /> Wetland Buffer Permit $10 Date Paid <br /> Planning Sign S50 Receipt Number <br /> PUO $350 <br /> PUO Amendment $150 Date of final action <br /> APPRCVED ❑ DENIED ❑ TABLED 0 <br /> Oate Z y+ Planning Case No. ^C.%"� - Admin.Account No.., ,". / ^' <br />