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raQUI^D SUBMITTALS <br />i Completed Application Form. <br />W ____Describe request in detail <br />A ^ ____ <br />5. <br />6. <br />?7"f T*" “I* pi" ™p (yo“ <br />*r ** l*^ •"»Is ”>«P from^mepin County Department of Finance, <br />A-603, Government Center, 348-3271). 7C/O <br />^ S-oSn"^ “"'*y <br />-----Attach legal description to application if not included on required survey <br />““ ““O'”) If '“<• "‘""ions involve <br />8. <br />9. <br />changes in elevation (grades). <br />-----List of the legal names (include marital status) of all persons with an interest in the <br />REQUIRED TO SUPPLY 30 COPIES OF LARGE DOCUMENTS OR C opy <br />suS^nrS^^^rSIff^r^ ^ smaller ) for all documents <br />^ documents, plans, etc. to be <br />The Applicant and Property Owner must sign this appUcation. Please tu.f . <br />application is not complete if the above information has not been included. <br />Sl?"s"fcien^cri sis! ^ " '““P'"'' <br />APPLIC.A\T'S signature <br />■ne appUcant hereby agrees to provide all infonnation required or requested by the Sonina <br />A^stritor, agrees to pay additional fees (staff time not covered by oriiSal fert.™^n <br />and/or unusual expenses incurred in review of this application and cettiLs ftai! J f.r <br />supplied is tnre and correct to the best of his/her mfoimation <br />V ^ / <br />Applicant's signature ' "^L^.LV ^ Date \ ~bl • O ^ <br />OWNER’S SIGNATURE <br />The owner hereby acknowledges and agrees to this application and further authorised re«ftn.Kt, <br />entry onto the property by City staff, consultants, agents, commission members* and Council <br />members for purpose of investigation and verification of this request. <br />Owner's signature J>^6V) tV f? 6*. /mvivv IJ Date 12 -bl-Q •? <br />Applicant cuisi have all submittals into the Citv ofTicei 25 m ^ <br />a ^■». 1ft n <br />c ••a 4 <br />4 4/ <br />* •