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fCf <br /> (i•111 <fir: COMMUNITY DEVELOPMENT DEPARTMENT <br /> • =• DEVELOPMENT APPLICATION <br /> R 2401 Highway 10, Mounds View MN 55112 <br /> ''s."'•Partneri*/' 612-784-3055 <br /> 612-784-3462 -FAX <br /> Please Type or Print Information-Complete Both Sides of This Form <br /> Applicant Information / [� & 4 <br /> Name of Applicant 23 <br /> ( ,��`� , Telephone 2 'q S 3 <br /> Address d o`0--19DD__ Or c77 ' /j Fax <br /> ////f 1,tot0 liff, 4)47//4 •• <br /> Interest in Property(check appropriate box) <br /> kOwner of Property <br /> ❑ Contract for Deed Owner <br /> ❑ Lessee,Operator,Manager <br /> ❑ Agreement to Purchase <br /> ❑ 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 /> �perty owner must sign this application for it to be accepted. <br /> gro a Description/Proposal <br /> rty y� Q <br /> Address or General Location .2 a oC 9 CY�d trot DJ) , <br /> Legal Description ..__,..¢A....\,,,A,�f 3 L al Le e C <br /> Property Identification#(PIN#) 0 5 .303 Y.3 O d <br /> #of Acres ).-7) f d 0 5 >= • R3 G a_cna_.,--C <br /> Current Zoning G``- <br /> Present Use Type of Application <br /> o Undeveloped/Vacant 0 Couiprehcnsisrc Plan Amendment $200 <br /> X Single Family Dwelling 0 Rezoning $200/ac;min$200 max$1000 <br /> ❑ Duplex/Two Family Dwelling ❑ Major Subdivision $250+$250 deposit* <br /> ❑ Multi-family Dwellings ❑ Minor Subdivision $150 <br /> ❑ Business/Commercial Establishment ❑ Planned Unit Development(PUD) $350 <br /> o Industrial Establishment ❑ PUD Amendment $150 <br /> ❑ Other(explain) ❑ Conditional Use Permit R-1,R-2$75;all others$200 <br /> X . Variance 42-14 R-2, ;all others$200 <br /> ❑ Code Appeal $75 -- <br /> ❑ Develop Review/Site Plan $100/ac;rain$100 max$500 <br /> ❑ Wetland Alteration Permit $50+deposit* <br /> ❑ Wetland Buffer Permit ? <br /> ❑ Floodplain Permit $200 <br /> • ❑ Other <br /> *see Municipal Code for explanation of deposits <br /> Please complete the reverse side of this application. <br />