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� <br />�; <br />Mounds Vi�w Planning Appl <br />����er�t lis� of P�op� <br />c s S�3 � r,�. � C���-�; c� I�,� ; I ��.� <br />��'ope �l���i�i��ti�r� ? Abstract ? %rrens <br />��S�ripts�� �f ��6��s�1(at�ach additfonal supporting documentation if neeessary} _ <br />Page 2 <br />��ae IYo : App cants are <br />Such fees a to paid in es+ <br />nok limited co for consuit <br />also be req Ir Eo cover cost <br />associated ' this applicati <br />amount. A portionofthe � <br />of the ap atian is comp te <br />I ACK WL D�E THA � <br />nt <br />�,.% <br />. . . <br />Name of App[icant (' <br />Signature of Applica <br />�..�. <br />� <br />le ll costs incurred assoclaeed wikh the filing, review and processing of this application. <br />�o 'or upon rscelpt nf statement from the City of Mounds View. Fees may include but are <br />i b the City, consultant planning servlces, attorney, and engineer fees. A deposlt may <br />, n tic s, materiels and staff time spent 3n the review, research or preparation of materials <br />p ica t shail be responsible for ail reasonable incurred �osts in excess af the initial depasit <br />• pe ar eneumbered shali be re€unded to the appii�ant within 30 days after consideration <br />ent park dedication fees is required with suhdivision applicatians. <br />all f Yhe inf atlon fisted in the Planning Applicatlon and fuliy understand that X am <br />� relate the processing oFthis appiication. PA jC� �� � <br />V� 7 <br />Date <br />, � - <br />1: �3 �J " .'.� ,�� '. � , � <br />, , � � .., �.,�„ <br />' � � " { � . , ) � ,- � .. !� _. _ �,. ", <br />-. � �. , � �z� <br />y• � <br />Name of Property Owner (typed/ i d) <br />� �'1 �"C„ � �L ( � <br />Signature of Property Owner �'�� <br />Address of Owner ��-i �7 yZ� C-v. ,�� � r� .�- �1 i�.:��t� J��,.� � n,; 5� E� Z <br />Phone Num r of Owner � t �� � � ���- '` � U' � ` <br />E-mail 7� Lt� �_t,��__(G o1�l� �� LU--, <br />��*�****�:**��:�*�:��*�****�*���*�*�*�*��x�x�*���***�**�:x**�***��x**�***�*****�*�:�:*��*��*���** <br />FO� �FFI�E dlSE O�ILI' <br />Date of Submittal -� R- Q� Date of Acceptance: <br />60-day L{mit 120-day limit: <br />Planning Case No(s) .�/�� c�c-�� �' Assigned to: <br />Fees Paid: Account # <br />Application: �� �• °� � o � � � � � <br />Park Dedication: <br />Deposits: <br />Other: <br />Tota 1: <br />Check # Recei�t # <br />� � C� � _ i ,�f.� �- � <br />io�oz <br />