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i <br /> 1 1 ©WPM% COt DEVELOPMENT DEPARTMENT <br /> III 1.--, ,S5 DEVELOPMENT APPLICATION <br /> ighway 10, Mounds View MN 55112 <br /> ~`?est•P.rtnt= 4 612-784-3055 <br /> 612-784-3462 -FAX <br /> Please Type or Print Information-Complete Both Sides of This Form <br /> Applicant Information <br /> Name of Applicant ,4.yL ){} d/..z1j Telephone .A[. —��6/ <br /> Address 11-ai v7�l?tz5 A o4-ike_ Fax <br /> Mt, A cis J t1 p ) "14) <br /> I terest in Property(check appropriate box) <br /> 0 Owner of Property <br /> Contract for Deed Owner <br /> ❑ Lessee,Operator,Manager <br /> ❑ Agreement to Purchase <br /> O Other(explain) <br /> Applicants must provide evidence of interest in property at the time of application,and if you are not the owner of the <br /> property,you must provide a letter of permission from the owner giving consent to the filing of this application. The <br /> property owner must sign this application for it to be accepted. <br /> Property Description/Proposal <br /> Address or General Location S—c?/ 3 B r'i e- h-}''P-\ LGL v\.,'�___ <br /> Legal Description ,/ d ()& L X i,�,�,�, <br /> Property Identification#(PIN#) cl-7 3 O a-2 i{- 2 X r a-1. <br /> #of Acres <br /> ic2411....1._icil <br /> Current Zoning X- / i 4 ny ` <br /> Present Use Type of Application <br /> — et.' - __-_• ,_-. * Comprehensive Plan Amendment $200 <br /> 0 Single Family Dwelling 0 Rezoning 5200/ac;min$200 max$1000 <br /> 0 Duplex/Two Family Dwelling ❑ Major Subdivision $250+S250 deposit* <br /> 0 Multi-f1mily Dwellings 0 Minor Subdivision $150 <br /> ❑ Business/Commercial Establishment 0 Planned Unit Development(PUD) $350 <br /> ❑ Industrial Establishment ❑ PUD Amendment $150 <br /> 0 Other(explain) 0 Conditional Use Permit R-1,R-2$75;all others$200 <br /> ,...-:-1157 Variance R-1,R-2 S75;all others$200 <br /> ❑ Code Appeal $75 <br /> ❑ Develop Review/Site Plan $I00/ac;min$100 max$50u <br /> ❑ Wetland Alteration Permit $50+deposit* <br /> ❑ Wetland Buffer Permit ? <br /> ❑ Floodplain Permit $200 <br /> • 0 Other <br /> *see Municipal Code for explanation of deposits <br /> Please complete the reverse side of this application. <br />