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CITY OF MOUNDS VIEW <br /> PLANNINGAPPLICATION <br /> APPLICANT:_ > �.. v- Phone = <br /> - <br /> y73�� <br /> ADDRESS: ROd/ �` _s ..eioc/ ,E'a/ <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 /> O 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 requeet <br /> • <br /> PROPERTY INVOLVED: <br /> • Address/General Location eY04/ octi <br /> Legal Description or Property Identification Numbers 6/ Sepz-„` a 1 ,.G <br /> Legal Owner: Name/Address . iP,,Q//zsese- F�6t 1 scc ieq-/ <br /> Present Use (check appropriate box): <br /> ❑ UndevelapedNacant <br /> • L� Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling v - , -_ <br /> ❑ Multi-Family (No. of Units ) <br /> ❑ Business/Commercial Establishment <br /> ❑ Industrial Establishment <br /> ❑ Other (explain) <br /> Property Classification: ❑ Abstract '` ❑ 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 /> levevrirtveirgriVritirineirseirirseintrirvrartraititirieveiratirwirfrelrlivelevrsrstiriraititirinirirsrervirlivorarritirwirinralrorimilrielreritli—stirst It it <br /> Signature <br /> Rezoning $200/acre.minimum$200.maximum$1,000 Park Find Dedication Fee <br /> Variance R-1 to R-2-$75,sit others$200 Data Paid <br /> Conditional Use Permit R-1 to R-2-$75.ail others$200 Receipt Number <br /> Code Appeal $75 <br /> Develop./Site Plan Review •.• acre.minimum 100.maximum $500 Total Fees Paid 4 /50 <br /> Minor Subdivision $150 Data Paid <br /> Major Suodivision _ " plus£250 deposit Receipt Number r a <br /> . Como. Plan Amendment $200 <br /> Weiland Alteration Permit $50 plus deposit determined by Staff Additional Fee Paid <br /> Wetland Buffer Permit Si 0 Date Psid <br /> Planning Sign $50 Receipt Number <br /> PUO $350 <br /> PUD Amendment $150 Data of nnat ac000n <br /> APPROVED Q DENIED r TABIC Q <br /> Oars T-7 ` '?CY Planning Case No. LiSq—q Admin.Account No. <br />