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CITY OF MOUNDS VIE' . . . --. <br /> -:LA. r IN€77 r PSC-;::%;? - <br /> • APPLICANT: L 4 W R N C I' W. Ki—a---A4-7.._ Phone 7 0— 578 3 <br /> L41vrjL Z676,-'-3(100y <br /> ADDRESS: Z -7 P ' k — di. • ir w Vf=- L \ . nil . <br /> Street Address, City, State, and Zip Code <br /> Interest in Property (check appropriate box): <br /> Owner of Property <br /> ❑ Contract for 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 /> PROPERTY INVOLVED: <br /> Address/General Location_ AME AS P BO vi- . LO <br /> OF P�Ui,ur ( .,--r-1:2..i<i=T oN P) NJ F W OD 1,RiV� <br /> Legal Description or Property Identification Number pi N 0 —. c)-Z3-'fif--Go 78 <br /> Legal Owner: Name/Address M L 4 APP Li -i,41\17- <br /> PL'f !41 U 44Y F iz4 L C_rzrht-r UNi0l4 4-04_1)S S moz:r-a/ 4,. <br /> Present Use (check appropriate box): <br /> ❑ Undeveloped/Vacant . <br /> III ®, • 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: ❑ Abstract ®, Torrens <br /> REQUEST: `r41�� ""i LVO DF)V=S R iE: 4L.Lo W=D • -11-}.05 1 NkiRt NC <br /> F-11.:'L i L►i i i-? AN iJ 1f1 LLC ;~r tR -rd. Fr-L- 1-4D 1J PrNi. <br /> 61--- �.�a=lZl -.t, l,Wrath iferari: v -y. , _.-_ . .-----t.. 1 �s -- iS5 • 1. _ __---SS <br /> *Please note: Applicant may be responsible for additional fees associated with the review of this request. <br /> CSe4 'c <br /> I HEREBY DECLARE THAT THE ABOVE STATEMENT ARE TRUE. � _.1 , /'/C. <br /> Signature �/ <br /> Rezoning $200/acre.minimum$200.maximum $1.000 Park Fund Dedication Fee <br /> anance R-1 to R-2-$75,all others $200 Date Paid <br /> on i anal Use Permit R-1 to R-2-$75,all others$200 Receipt Number <br /> Code Appeal $75 <br /> Develop./Site Plan Review $100/acre, minimum 100. maximum $500 Total Fees Paid <br /> Minor Subdivision S150 Date Paid �J 9 ,i, a <br /> Major Subdivision $250 Pius $250 deposit Receipt Number 4—(0 / S< ' <br /> Comp. Plan Amendment S200 <br /> • Wetland Alteration Permit $50 plus deposit determined by Staff Additional Fee Paid <br /> Wetland Buffer Permit 510 Date Paid <br /> Planning Sign $50 . Receipt Number <br /> PUO $350 <br /> PUO Amendment $150 Date of final action <br /> 3 0 APPROVED 0 DENIED 0 TABLED 0 <br /> 9 Date '/) -9 4' Planning Case No. — 614 Admin.Account No. <br />