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CITY OF MOUNDS VIEW <br /> PLANNING APPLICATION <br /> APPLICANT: t.-�` t; r t <br /> Li)t v o S S l c t v1 Phone 2S14 - 4/1/7V7 <br /> • ADDRESS: 8 K,0_ l Cc. r. <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: f, <br /> Address/General Location '1 5'5 I�ston <br /> Legal Description or Property Identification Number <br /> Legal Owner, �1�(I�(Ac dre Q ti o, k` nr) <br /> c, \ �Z t� 4t !)1,( v1 c ' E Lem , I 1 1 <br /> Present Use (check appropriate box): <br /> ❑ _ UndevelopedNacant <br /> Single Family Dwelling <br /> • 0 Duplex/Two Family Dwelling <br /> ❑ Multi-Family (No. of Units ) <br /> ❑ Business/Commercial Establishment <br /> ❑ Industrial Establishment <br /> ❑ Other (explain) <br /> Property Classification: ❑ Abstract 0 Torrens <br /> REQUEST: ) <br /> *Please note:—Applicant_may be responsible-for-additional fees associated;with-the-review-of this request <br /> I HEREBY DECLARE THAT THE ABOVE STATEMENT ARE TRUE. <br /> Signature <br /> Rezoning $200/acre,minimum$200,maximum$1,000 Park Fund Dedication Fee <br /> Variance R-1 to R� l others$200 Date Paid <br /> Conditional Use Permit R-1 to $7 I others$200 Receipt Number <br /> Code Appeal $75 <br /> Develop./Site Plan Review $100/acre,minimum 100,maximum$500 Total Fees Paid 9.5 '5 <br /> Minor Subdivision $150 Date Paid /'J - - a 5 <br /> Major Subdivision $250 plus$250 deposit Receipt Number y <br /> Camp. 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 ❑ DENIED 0 TABLED 0 <br /> Date /0/A/9,5 Planning Case No. Admin.Account No. <br />