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:i ; ;' � ; � ; �: I''� '- ��' • � � �_ �.. � , .�* �� t � _. �'l�r'...w _ �.j%�;�t�� .., f��,- � � � _ . � �%r � � � � �� 4f . .i�:.., � . .� �� " '� "�.�_, � __ _ --� �.s�� _ � ��. � . � _ �r sa* Interest in Prape�ty ❑ ❑ � a (check appropriate baxj: Obm�r of Property � Contract far Deed Owmer Lessee, (?per�tor, Manager Agreement ta Purchase other �explain} Documenlary evidence of �piicanYs iriterest in ihe property may be r�uired betore final City aciiort af this requesY. ��d�E�� NVOL�E�: Address/Gerreral Locatic Legal Description or Property Identifica�io� Number �,egai owr�er: Name/Address � 222°l Ve..��1�' �i`�1 ��! �_ Sa ,Q(��. Present Use (check appropr€ate box): ❑ UndevelopecfNacant - �, ❑ Sir�gle Farnily Dwell�ng - ' ❑ Dupfex/Two �ami(y Qwefling ❑ idiu[ti-�amily (No, of Units _ ) ❑ Business/Commercial Estabfishrrrent ❑ Industriaf Esfablishment j� Other (expiain) ' Property Classification: ❑ Abstracf ❑ Torrens _ � '/ : � i _ . � . � � i � . +i �i � � _ �► � 1 1' 1� � � 1_ . • , �. y � , � _ . _. . •.. � � � � '_ ' . s . �,�._, ��. r e � � � i _ . : ,.a .� 1!, � rL. � � � � � il a . . 1� � � *Please note: Applicar�t may be responsible for additsonal I HEAEBY DECi�4RE THAi TH� ABOVE STATEMENT ARE � Signature *��$*�,��*�*��*��**��*��,��*��*�*��,��*�*��*��*��-��*�� ReZOnin9 $200Jacre, minimum $200, ma�dmum S4,9QQ Park Fund Dedieation Fee Variance R-1 to R-2 - 575, a[I athers S2Q0 Date Paid Conditional Use Parmi# R-1 to A-2 -$75, ali ofhers $200 Receipt Numbee Cod� Appea� Develop./Site Pt�n Review Minar Subdivision Major Subdivision Comp. Plan Amendmen4 Wetland Alieraiion Permii Wetlaezd Buffer Pennii Plerrning Sign PUO PUI� Amendment Date $75 $� OO/aere, minimum 100, ma�dertum 55U0 $15a S250 plus $25� dapasit $200 $SQ pius deposit determinect by S4aff $� 0 $b9 $350 $15� Total Fees Paid Date Paid Receipt Number Additional Fee Paid Date Paid Fieceip4 Number Dat,� of finel action APPROVE� Q DENl�p ❑ TABLED ❑ Plenning Casm Ple, Admin. Accaun4 No.