06-14-2004 Council Packet - Laserfiche WebLink

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• • • •• V required submittals 1. 2. 3. 4. Completed Application Form. Describe request in detail. Certified Property Owners List of owners within 350' of the subject prooertv labels and plat map. List, labels and map may be obtained from Hennepi- county Department of Finance. Government Center. A-603 300 South Street. Minneapolis, telephone 612-348-5910). Cerfifiratfl nf Qui^av / ______i 5. 6. 7. 8. 9. "sJiCeyfnLmfton'''' ® ‘ ^'andout for _ Attach legal description to application if not included on required survey _Topographic survey (existing and proposed contours) if land alterafons involve changes in elevation (grades). - th? of all persons with an interest in owner(s?^^^ ^ include name(s) of applicant(s) if not current Construction plan, if applicable (see staff for requirements). As an addendum to this application, piease attach a separate list of anv o‘he' persons you wish notified of this application. y 'J- '«■ c2o ™ required to supply 3 COPIES OF LARGE DOCUMENTS AND 1 COPY suTmTtSf drawings of r°d''ofum^nt°s!'p'^^^^^ to be The Applicant and Property Owner must sign this application. Please remember that vour application is not complete tf the above information has not been included. ^ fnScf °aerica?lS' Applicafen is ccmptete. APPLICANT'S SIGNATURE agrees to provide all Information required or requested by the Svmpnn rpay additional^^s (staff time not covered by original fee 2^® application, and cert^es thatthe information supRUe^is^^e and Mr^j^,^jhe best^is/her knowledge. Applicant's signature Date OWNER'S SIGNATURE r / The owner hereby acknowledges and agrees to this application and further authorized reasonable ent^ onto the properly by Cih, staff. cSsgItants agenrcoriSn request'"’ T" v.-s„ation of this Owner's signature~ ^ ^ ^ ^ Dafp M # M ^ ^ Applicant must have all submittals into thc^itv offices TStiau^ J— • iT -■*. *.---------— • # •, •V Ij u 1 Ir* .ervt, • -> /T. • i k ■Bib