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pimanUC_Z^22U <br />teRgcdvcd <br />lountPaid ^ , <br />■ftOSH____________ <br />me)________________ <br />to___Zip_555ai___ <br />me) i»yi* 2Z>«Ar» <br />ffk) >ti* SH^l <br />►aUis Zip yy4i^ <br />mn (month/year) <br />ices) <br />7. <br />REQUIRED SUBMITTALS <br />~y^ Completed Application Forai. <br />2* - Describe request in detail. <br />^ Ccrtifi^ Property Owners List of owners within 350’, labels and plat mab fvou <br />murt ob^ this list, labels and map from Hennepin County Department of Finance <br />-A-603, Government Center, 348-U?i^).5^tO <br />^ Sfo^Sion*^ Survey (signed by a licensed surveyor) - refer to handout for survey <br />-------Attach legd description to application if not included on required survey. <br />------- opograpluc survey (existing and proposed contours) if land alterations involve <br />changes m elevation (grades). uivuivc <br />List of the legal names (include marital status) of all persons with an interest in the <br />R property. This wodd include name(s) of applicant(s) if not current owncr(s). <br />?• ConstrucUon plan, if applicable (see staff for requirements). <br />addendum to this application, please attach a separate list of any other <br />persons you wish notified of this application. <br />SUPPLY 30 COPIES OF LARGE DOCUMENTS OR COPY <br />suBMnrro VS—1/‘* * *'or all documents <br />sutodttedl*^*^ drawings of alf documents, plans, etc. to be <br />Property Ovvner must sign this application. Please remember that your <br />application is not complete if the above information has not been included. <br />CctrificatiOT by Clerical Department that Land Use Application is complete. <br />Imtials of Clerical Staff: ___________________ Dajg <br />APPLICANT'S SIGNATURE <br />The applicMt hereby agrees to provide all information required or requested by the Zoning <br />Admimstrator agrees to pay addiUonal fees (staff time not covered by original fee payment) <br />Date io/ot AApplicant's signature <br />OWNER'S SIGNATU im:. - <br />Owner's signature Date /g/g/ <br />Planning Commission Meeting. <br />“as a* T"" <br />•* -•••. « <br />r.( :t