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COMMUNITY DEVELOPMENT DEPARTMENT <br />00MO PLANNING APPLICATION <br />UI 24o1 County Road jar Mounds View, MN 55112 <br />`N 4 (763) 717-4020 <br />t�'xr + <br />Parw-rs ; Fax (651) 765-1660 <br />please Type or Print Information - cornpiete Both Sides oaf This Form <br />Applicant Information <br />Name of +4pptir�n# � r, � v{ �-� t �� � 1 � r�[ephone- <br />Adddressl�;#' Fax df/ �f <br />E-mail <br />interest in Property (check apprwtat3e box) <br />0 Cwner of property 0 cant mct for Deed owner <br />0 Lessee, Gperator, Manac er 0 Agreement to PLirchase <br />,-[;V other (expia'In) ni 4 oyL A bsr-- --3 - l <br />� <br />Appllcants azzIst provide E: vidence ufrnterestI" PrWetf'at fire time Of�rPP11cafior►, andif <br />you are not the Owner of the ProPcrtY, y0a must a ether provide a letter ofpsnn,"fan frvn" <br />the owtre► giirirrg consentto the flingoFthisapvlIC060rr arthePrape�rfYow —mu stslr�n <br />this eppllcation for it to Ge acreptsed. <br />Property Descriptlion/Proposaf <br />Address or General Location <br />legal Descrlpttan' <br />Properly IdentiFicatian E 2-- <br /># of Acres ; . r <br />Current Zaning---- <br />Tvcm of Aipplication (Pleaw chack the appropr#ate lsoXes)'- <br />Page 1 of 2 <br />F(z <br />1 6 D 3a4)� <br />Q—�c D 0 I' <br />