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CITY OF MOUNDS VIEW <br /> PLANNING APPLICATION . -.' ... <br /> APPLICANT: ,; • <br /> .4 <br /> Phone 75L-'9O78 <br /> • ADORESS[77.5-5-S i141 11t A.C.Pettd 11x1 all tr IS Vi e�r �ti X S 110_ <br /> Street Address,-City, State, and Zp Code <br /> Interest in Property (check appropriate box): l <br /> Owner of Property \. <br /> ❑ Contra for Deed Owner <br /> Q Lessee, Operator, Manager <br /> Q Agreement to Purchase <br /> • <br /> Q Other (explain) <br /> Documentary evidence of applicants interest to the property may be required before anal City action of this request . <br /> PROPERTY INVOLVED: <br /> Address/General Location <br /> Legal Description or Property Identification Number A,o f 24c5e e-0761-,"e30 °�3 — 3�-� <br /> ri <br /> 7---id/lc? 3tl A7art�g e 3.3, 9'gt6j ty <br /> 1- -,-e R /J - hN •10 "4+•al s•1PQntsrye- - <br /> Legal Owner: Name/address -z-re A n R- Cyt 4 no/n <br /> 5 r,n5 �a ke Ro 4.cii Mori reds v,'ta> Milt 5-S1/ <br /> Present Use (check appropriate box): 3 <br /> Q UndevelaaedNacant <br /> - <br /> • Single Family Dwelling <br /> Q Duplex/Two Family Dwelling - ..-.. -_ _,.-__.. ----- ------.'—'-- <br /> Q Multi-Family (No. of Units ) <br /> Q Business/Commercial Establishment <br /> Q Industrial Establishment <br /> Q Other (explain) <br /> Property Cassi cation: [ Abstract g. Tarrens " <br /> • <br /> REQUEST: TF,.-f- tear ;once_ �e y ert =,(1 . --- e.a n u 4e <br /> a - - 7178 d;n e' .4.01- <br /> WBEImmmeliSAer <br /> v i�r`m.--ar�SL7lliEi - ZTT.=�..7.'_i - - ' ;-f <br /> *Pease note: App,' may be responsible for accitional fees associated with the r- iew of this request. <br /> I HEREBY.DECLARE THAT THE ABOVE STATEMENT aFE TRUE. _ I <br /> Signa* = r <br /> ..#1 <br /> • <br /> Sewn" - 5200/acre.minimum S2CO.maximtun 51.000 Paris Fund Dedication Fee <br /> R-1 to R-2.57ail others=CO Dana Paid <br /> - .anal Use Permit R-1 ts P-2-575 ail others 5200 Receipt Number <br /> Code Appeal 575 <br /> Oeveico.iSite?tan Review 5100/acre.minimum 100.maximum Mia Tatal Fees Paid 73 <br /> Minor Suoorvision 5150 Oats Paid <br /> Major SuodSC50 pias 5250 Receipt `9 1„_ <br /> deposit Pscot Number 5'a g <br /> . Camp. Man Amendment 5200 <br /> Wetland Alteration Psrmrt S50 plus depose determined by Staff Additional Fee Paid <br /> Wetland Surfer Permit 510 Oars Paid <br /> Planning Sign SSO Receipt Number <br /> PUO 5350 <br /> PUO Amendment 5150 Data at Inal ac^„pn <br /> p APPROVES C DENIED 77TASL-777 <br /> 96/ <br /> Oate J " - Panning Case No. q 5 Q `I /,, <br /> �/ Admin.Ac=unt No. h ''er <br />