|
�
<br /> ����_-
<br /> . �I°�� �7►� ��"C�►��C�
<br /> �"�r������ �►��M���t���
<br /> _ S;i�el�+ddress: Application# ��---y�'1�-
<br /> ,:,�%`",-`� �,7`��� �:75t1 Kellc>y Parkway Uate R�.�ceivpd� �}'�-?i,-�_
<br /> r��.
<br /> �� )" '`! ` •�, C�runu, MN 5535fi �,mourit F'air1: ,� ��y_
<br /> � � �; ��';\ St�ff: ����–�-(�.--
<br /> ,l t�?;•,�`.;,,,.. 1'� lVlain: A52-24y�au'UC FE 6��bs..�LG�._:�I� --
<br /> ��,� ''v'�%;9��::' �,1� c�: �,._ ___—� __.
<br /> `� ` � �Y� fax: 9:>2-249-��16 ,
<br /> .•� �,.�; Ftenr:oval: �3U0 - —
<br /> •\�> ',��Vy ,�� ��/� lula�tirrqA�lclr�ss: ARPr-the•�factV :fi1,20G Double Fee
<br /> ��:�.����� 11�;�vji F'.C?. 8ox 66 --- -----------
<br /> ��'���--�� Crystal t3ay, MN 5a:i23-OG66
<br /> Thi=; application forrn must t�r: corr��lr:ted in iuli. Applir�nt wili t,e nc�tified u�ithin 1S days �s to !he stetus flf the
<br /> �,ps��ication. Irrcompl�t� �p��i��t��ns will r�ot be pl�c�d �n �'i�r�ning Coc��mi��i�s� Ag�n�d�s.
<br /> PRC7�+��.TY 1NFQRl�IlAT6tJ�1: �bUd`#�
<br /> Site Address: ��.�.�_�D�-����0�_.�_.___�-_� '���l"�t� . #"E�� '�'���—
<br /> Pr�pPrty identi ir,ati�n C�ur�nber (F�INj: ��__�_�_�'� ._��b(�h� _.^_
<br /> (��,ttach legal descriptinn tn application if o inc?udec! c�n the survey.)
<br /> Date Pr�periy Acquired fmonti�;year}: ��I�❑ Yes, I own the a�jacer�t parcels.
<br /> f'r�sent use of prop� I� R�s�c�enfial � Qther _u � _
<br /> Zoning bistrict L�-- ! �`.,,,� ��~ -- —�—��- —
<br /> APPLiCC1�liV7 INFO�'iMAT1UP�: ;Con�plete legal names and marital stalus required fc�r each int�rested party)
<br /> Narr�: �ID� --�_���.J 7�O 1�-�-----
<br /> Phr�ne {h�rnel: Phone (work): Z���2-_�tacx��'�
<br /> Addra�s: _,'�de0' �,ri . __,.�34'17"�- s�es �it}�: . Zi
<br /> . , �....-����� ' ----- ���-`7--—- p. `�'�`
<br /> E m a i I. {5[�x� ,�,,,.. l�.r-�!�T�� ,--�rc.,c�i a�.4-r� _ F�x: �+Z�.' �-_'r�'� �J
<br /> --�-._ .�._ . ts,�+-� � -`�--------
<br /> �V10N�R �NFQRMATION: (Cornplete legal names�nd marital stafus required for eacn intere�tFd paRy)
<br /> Name:
<br /> Phone (ham�): _--..^_J �. F'hone (wark): _ --^ _� --
<br /> Address: City: �ip:
<br /> -------------._..._._.. _.- -- ------------
<br /> ErT7�iL Fax:
<br /> UESCRIPTiON OF f��Qt���T: Estsmated Proj�ct Cost: $ ____
<br /> L�escribe the r�sques: in detail (attach additional sheets if necessary);
<br /> ,�i �f �Y_q,.
<br /> * y� ,,fr,�>�,�},,,, �,�.� --.:.�.. E * ��.e
<br /> � � r �. 9 i�°•
<br /> Q, S Y
<br /> �,yp��f+�'J 4:s �F� ��t EL��::ti..^�4 rt,L �`1.��:3
<br /> ;� �.�A j �i17 4��y :
<br /> � �� ��� P� ���,� rt� ,� �.
<br /> � ��� ��..�.�Fa ���'� `��' �
<br />
|