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( <br />Moc�nds View Planning ,4pplica��vn <br />�� � . �.: <br />y` � . �. - ��� :��: � � . <br />❑ Torrens <br />D�sc�°ip�i�r� �f P�°opc�5�l (attach additionai supporting documentation if necessary) __ _ <br />-(� Q c�"% .� �� .�. �r.�/� <l.� _. /r.����� - — <br />Please i�ote: Applicants are respons'sble for all eosts Incurred assoeiated with the filing, review and processing of this applica�on. <br />Such fees are to be paid in escrow up fr�nt or upon receipt of statemeni from the City of Mounds View, Fees may include but are <br />not limited to costs for consultants retained by the City, consulCant planning servfees, atiorney, and engineer fees. A deposit may <br />also be required to cover costs of pubf ic notices, materials and stafF time spent irt the revlew, research or preparation oP materiais <br />associated with this application. 'ihe applicant shall be responsible for all reasonable incurred costs in exeess of the initial deposit <br />amount. Any portion of the depasit not spent ar encurrrbered shal! be refunded Yo the applicant within 30 days after consideration <br />of the applicaYion is completed. Payment of park dedication fees is required with subdivision applications. <br />I ACKNOWLEDGE T�1AT I have read ali of the information fisted in the Pianning Application and fulfy underskand that I am <br />responsib for afl osts ' curred by the City related to the processing of this appl'scation. <br />� <br />�` 'i ff � <br />App' - Date <br />Page 2 <br />�Y [�7Y {�LBR) SYGNATURE ON THI� APPL�C�►l`30N, I IiER��Y ��C�4R� TFie4`F, �°O 1"HE <br />��ST OF l+�Y KNOI�JL.EDGE, i6iE IN��R�9ATIOBV P�OVIDED IS TRiJE' �,ND �►C�U TEa <br />� <br />Name of Applicanfi (typed/print�} K /�� �� (� �,�� •r--� <br />Sgnature of <br />Name of Praperty <br />Signature of Prope <br />Address of Owner <br />Phone Nurnber af <br />E-rnail _ ��1 �,-�-�`G_f <cJ _��C�_ �=� � <br />�**:���x:���*��*�**�**�*�*�*****��*��*�*��***�**�*x��*�****�����**�****:��x�=��x***��**x��*�x�**� <br />FOFt OF�I�E 11�E �i�L� <br />Date of Subrriittai �°� o' � 3 Date of Aceeptance: ..3 r�-� - b� <br />60-day Limit 120-day limit: ___ _ <br />P�anning Case No(s) �S n� •� n�J, Assigned to: _ <br />Fees Paid: Aeeount #k 'I Check # Receipt # <br />Application: •�.5 �.c�� a.,.� � o� � `-�T �%/_5 �7 1.3�f � = <br />Park Dedicatior�: <br />De�osits: _ <br />Qther: <br />Totai: � <br />� o�az <br />/� <br />