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A <br />.*eel. ' Pacmers*e' <br />Applicant Information <br />Name of Applicant <br />Address <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />DEVELOPMENT APPLICATION <br />2401 Highway 10, Mounds View MN 55112 <br />612-717-4020 <br />612-784-3462 - FAX <br />Please Type or Print Information - Complete Both Sides of This Form <br />/7I o 4/nt y S//1--7f o w S %OK E Telephone 6 (Z - 7'z --/u U Z. <br />(Clow BPS /%/Lw <br />a73 Z Nwy /o <br />/`10 u ti /2J v (F c-v / V/J 3 37 I z <br />Fax to (2.— 7?2 — lhf 7 <br />Interest in Property (check appropriate box) <br />Owner of Property ❑ Contract for Deed Owner <br />o Lessee, Operator, Manager ❑ 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 />property owner must sign this application for it to be accepted. <br />Property Description/Proposal <br />Address or General Location <br />Legal Description <br />Property Identification # (PIN #) <br /># of Acres <br />Current Zoning <br />()0 v fr /b d- f Lv/=.e �Ji�G�r /Cc <br />Lk. i , 5 X I / �c tcx,✓uuw �S i-t-%-�S <br />✓C, ao a-3- 43 001,' <br />Type of Application <br />❑ Comprehensive Plan Amendment <br />❑ Rezoning <br />❑ Major Subdivision <br />❑ Minor Subdivision <br />❑ Planned Unit Development (PUD) <br />❑ PUD Amendment <br />Conditional Use Permit <br />❑ Variance <br />❑ Code Appeal <br />❑ Develop Review/Site Plan <br />❑ Wetland Alteration Permit <br />❑ Wetland Buffer Permit <br />❑ Floodplain Permit <br />❑ Other <br />$250 <br />$250/acre; min $250 max $1500 <br />$250 + $250 deposit* <br />$200 <br />Refer to rezoning fees <br />$350 <br />R-1, R-2 $75; all others.$250. <br />R-1, R-2 $100 all others $25O- <br />$100 <br />$125/acre; min $125 max $750 <br />R-1, R-2 $150; all others $200 <br />R-1, R-2 $25; all others $100 <br />$200 <br />*Deposits shall be paid to cover all costs of public notices, materials and staff or consultant time spent in the review, <br />research or preparation of materials associated with this application. The applicant shall be responsible for all reasonable <br />incurred costs in excess of the initial deposit amount. Any portion of the deposit not spent or encumbered shall be refunded <br />to the applicant within thirty (30) days after consideration of the application is completed. <br />Please complete the reverse side of this application. <br />