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REQUIRED SUBMITTALS <br />____Completed Application Form. <br />/2. ____ Describe request in detail. <br />* -------Certinrf Property OuTiets List of oilers wiihin labels and plat map (you <br />must obtain this list, labels and map from Hennepin Count\- Department of Finance <br />A-603, Government Center,~34»9?yi). Uf/Z ’J>/S~S’VD <br />^ ------- Certificate of Survey (signed by a licensed surveyor) - refer to handout for survey <br />information. <br />_____ Attach legal description to application if not included on required surv ’cy. <br />----Topographic survey (c.xisting and proposed contours) if land alterations involve <br />changes in elevation (grades). <br />— List of the legal names (include mantal status) of all persons with on interest in the <br />property. This would include name(s) of applicani(s) if not current owiier(s) <br />— Construction plan, if applicable (see staff for requirements). <br />— As an addendum to this application, please attach a separate list of any other <br />persons you wish notified of this application <br />YOU ARE REQUIRED TO SUPPLY 30 COPIES OF LARGE DOCUMENTS OR COPY <br />SMALLER) FOR ALL DOCUMENTS <br />Sl^MiyED. (Staff will require to scale drawings of all documents, plans, etc to be <br />submitted.) <br />The ApplicMt and Property Owner musi si^n ibis applicauen. Please remember that your <br />application is not complete if the above information has not been included. <br />Certification by Clerical Department that Land Use Application is complete. <br />Initials of Clerical Staff:________________________ <br />5. <br />6. <br />8. <br />9. <br />APPLICANT S SIGNATURE <br />pie applicant hereby agrees to provide all information required or requested bv the Zonina <br />Administrator, agrees to pay additional fees (staff time not covered bv oriainal fee pavmcnO <br />andor unusual expenses incuned in review of Uiis application, and certifies tliat the inferination <br />supplied IS true and correct to the best of his,her knowledge. <br />Applicant's signature <br />correct to the best of* his <br />Date /n-m- O / <br />OWNER'S SIG.NATURE <br />Owned, signature Date IQ-Il- O / <br />scheduled review neelii,,. of die Planni-i, Cwnmusioo Jid CrJeJ h „ LS U a <br />Khcduled metnnf. please make amngemenu lo have an authorized agent aiten^^n vour /"'"a* <br />Building Sc. Zoning Office of this change prior to the meeting ^ P e and advise the <br />f-Ij:O 1