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LP <br />• <br />CM; OF <br />MJ <br />A <br />If ill Par toes.° <br />Applicant Information <br />Name of Applicant <br />Address <br />COMMLTNITY 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 />A: lml4r'F L L._ &rn.Pieb/Jy <br />DM /A-714410.1'4 OtIg AP>Mell <br />44D1 r-. lclos rirReFr <br />a$coom t J6 r J, m 'J 551-106 <br />Telephone 112 — <br />Fax (ail— '&5 <br />L - 4C0 <br />-33' <br />Interest in Property (check appropriate box) <br />❑ Owner of Property \ ❑ Contract for Deed Owner- <br />❑ Lessee, Operator, Manager `gyp 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 ,-Z")171- 5 4-6C i , (/-"‘ 3 VATS \ A Ed <br />Legal Description <br />Property Identification # (PIN #) <br /># of Acres <br />Current Zoning <br />.'� -p- :a- .3 a- q-S <br />Type of Application <br />❑ Comprehensive Plan Amendment <br />❑ Rezoning <br />• <br />❑ Major Subdivision <br />❑ Minor Subdivision <br />❑ Planned Unit Development (P <br />\ a 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 $ I St <br />$250 + $250 deposit* <br />$200 <br />Refer to rezoning fees <br />$350 <br />R-1, R-2 $75; all others $250 <br />R- I, R-2 $100 all others $250 <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 alter consideration of the application is completed. <br />Please complete the reverse side of this application. <br />