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ESOTA <br />on * <br />TYPE OP REQUEST <br />Subdivision $150^$5Aot <br />vo-^^tonditional Use $50 <br />variance $50 <br />Rezoning $250 <br />Riprap $15 ($65) <br />Date Rec*d <br />By" <br />FEE <br />Use <br />J/. Tfd A/! 4si <br />■i: '^3'1Cq3 <br />Side Rear <br />lrt*T^> SMi| ^"1 d <br />* ■ <br />» PR0P08AI, (or prop«ty, <br />/?.n <br />CWMBR Nane 6^Af/^ ' SS3^/ <br />Mailing “ ^------------------_ Tel # <br />Address <br />Present Zoning _ ^ <br />--------------------Present Use <br />zoning Ordi„«c Section Relating to Request <br />Specify ordinance Requlrementa <br />«*’« CP REQtTEST <br />Subdivision $150+$5/lo <br />—k^^Ttonditional Use <br />Variance $50 <br />-- -Rezoning $250 <br />Wprap $15 ($65) <br />a^min your r«,ue.t and rea«,n. fOr ,a« <br />/I- W <br />variance required - extent of nonconformitylot Area <br />Width Setback Front <br />O****”# eaqplain' <br />Side Rear <br />Specif hardships property _ . . <br />SUBDIVISIOH application Hesidential Otber, e3q>lain <br />_______________________ ®o. of Lots ____ <br />COMPmoBM, OBB Mm oiHm _____ __________ <br />property in detail <br />A^licatlon completed <br />Plat in^ section <br />Oonotructlon jrtane. 1* appUrabl. <br />5. <br />6. <br />Certified Property Owner's 11««. « <br />owners within oS') <br />Hennepin Oo. De^ ie .?®A-An» « oept. of Finance A 603 Government Center <br />anq>^g legal sized enveloBealeiA% <br />on the above list na»ae <br />■ f- AppUcant'a Signature Z' >- ^ /%• X <br />CX#ii#ir • 8i9natur# ^ _ tl / <br />“ sr-‘ =ss2.“iSr— <br />5/78