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�9sy <br />APPLICANT: <br />PROPERTY <br />CITY OF MOUNDS VIEN <br />PLANNING APPLICATION <br />Date <br />Address <br />�, /4 , >i- 7ep/ a77k, <br />Interest in Property (Check Appropriate Blank): V <br />Owner of Record Lessee, Operator, Manager <br />_ Contractor for Deed Owner _ Agreement to Purchase <br />Other (Explain) <br />Documentary evidence of applicant's interest in the property may be required <br />before final City action on this request. <br />Address/General Location <br />Legal C%vner: Name/ <br />Present Use (Check Appropriate Blank): <br />Undevelopea/vacant Apartment <br />_ <br />_ Single Family Dwelling Business Esabiishment <br />_ Duplex Dwelling — Industrial Establishment <br />Multiple Dwelling (3-6 units) - <br />- Other (explain) <br />Property „ assification: Abstract Torrens <br />tE,UESi: (Explain) Q A,., / • n <br />hereby declare that <br />the above <br />statements are true. <br />V/ , / I <br />-------------- - ------------------------------------------------------ <br />�R OFFICE USE ONLY: <br />sr ature <br />------------------ <br />TOTAL <br />BASE *(Base Fees <br />are Non-Refunaabl e) <br />DEPOSIT <br />FEES <br />Subdivision, Minor <br />SIUO <br />(3150) <br />RezoniSuDdiVnsian, Minor <br />g <br />S1UO <br />S100 <br />(S50) <br />(S5U) <br />ERe=me <br />4M: <br />Conditional Use <br />31U0 <br />_�< <br />(S5U) <br />Variance <br />S75 <br />(55U) <br />Ciae appeal <br />oration Permit <br />SIOO <br />3150 <br />(55U) <br />(55U) <br />Park Fund Dedication <br />?ran Review <br />3IUU <br />(55D) <br />Date Paid <br />Receipt Number <br />Uther <br />(S5u) <br />Aaat'l Fees ?aid <br />Ds:e Da': <br />Rccdldt llGGcer <br />