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iety of Mounds View,MN <br /> It.velopment Application Page 2 <br /> t Use of Property <br /> UndeveIoped/Vacant :r ❑ Single Family Dwelling <br /> Duplex/Two Family Dwelling 0 Multi-family Dwelling <br /> Business/Commercial Establishment ❑ Industrial Establishment <br /> D ' Other(explain) <br /> • <br /> Psgerty Classification . .__❑ - Abstract- --Ton•ens - <br /> •-- <br /> ascription o Proposal -- - 4 / - —. -- - ,• G 1 <br /> ''/47"? S r",e .� �+ �-7 _ / P i/. <br /> � - ]Ll.,� fir.�/i�' 10c <br /> • <br /> BY3fY(OUR)SIGNATURE ON THIS APPLICATION,I HEREBY DECLARE THAT,TO THE BEST OF MY -- :.a.' <br /> ICWLEDGE,THE INFORMATION PROVIDED IS TRUE AND ACCURATE:— <br /> Sigarture of Applicant . - _ . .. I <br /> Nae of Applicant(typed/printed) • r <br /> ��. ✓�1, ,.. �c. ._,� 1 <br /> Sigseture of Property Owner • ‘,47 <br /> .of Property Owner(typed/print-.i <br /> Address of Owner <br /> Phone Number of Owner „ - DD 1> 2-(7./ <br /> • <br /> FOR OFFICE USE ONLY <br /> Date of Submittal /-,9 - 9 9 •• <br /> Date of Acceptance Assigned to: <br /> Planning Case No. S-13 - 9 g 60-day Limit 120-day limit <br /> • <br /> Fees Paid: Account# Check# Receipt# <br /> Application: 75--O o 100--710*?a 3 9-A° 59 q(o <br /> Park Dedication: _ <br /> Deposits: <br /> 0 <br /> A. <br /> To <br /> 1.`,DATAIGROUPSICOMDEVIFORMS1DE VAPP.FOR <br /> 1/98 <br />