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required SL'BMITT.\LS <br />1, ____ Completed Application Form. <br />2. ____ Describe requcit in detail. <br />3 p*ricertv Owners List of owners within a-0 (you can ootain this list from <br />Hennepin Count)' Department of Finance. A-60a. Government Center. 3*^8-3271). <br />4. Plat Mao. . ... <br />5 Cenificate of Surrey (signed by a licensed sur-eyor) - rerer to nandcut tor sur/ey <br />information. <br />____ Anach legal description to application if not included on require- rar.-ey, <br />7 Tocosrachic sun'cv (e.tisting and proposed contours) if land alterations involve <br />changes in elevation (grades). ^ . <br />;8 List of die leatai names ( include .marital satus) of ail persons with in mterest in L^e <br />procerr*'. Tnis wouid include name(s) of applicont(s) if not current owneris). <br />9^ Cor*structicn plan, if applicable (see start tor requirements). <br />JO. .As an addendum to dus application, please attach a separate list of any other persor^ <br />veu wish notif.ea of this application. <br />YOU ARE REQLTRED TO SLTPLY 30 COPIES OF LARGE DOCOIENTS OR COPY <br />FOR REPRODL'CTIO.N (11 ” X 17" OR S>L\LLER) FOR ALL DOCL’MENTS <br />SUBMITTED. (.Staff wiil require to scale drawings or ail documents, plans, etc. to be <br />submitted.) <br />The Applicant and Preperr/ Owner must sign this application. Please remember ±at your <br />acclication is net compiete if tne above micrmation has not been included. <br />Certification by Cler.cai Department diat Land Lse .Application is complete. <br />Initials of Clerical Starr;^__________________________Date------------------------------------- <br />.Anciicant’s signarar^^^^^tzd! <br />APPLIC.ANT’S SIGNATURE . u . -r <br />The applicant herebv asrees to provide all information required or requested by the Zoning <br />Admumstrator. asrees to pay additional fees (staff tune not covered by onginal fee payment) <br />ar.cL'or*"unusuai e.xnenses incurred in review of this appiicaticn. and certir'ies that the information <br />supplied IS true and Innowledge. <br />Date 7/i-/^/f5_______ <br />OV\>'ER*S SIGN.ATLRE <br />Tne owner hereby aclcnowiedges and agrees to this application and turdier authorized reasonaoie <br />entr.' onto the preperr/ by Ciry staff, consultants, agents, commission members, and Council <br />members far ourpesey^' mves'ugancn^ v^fca^ of this request. <br />Owner's signarur^rZ^*^^***^ 'V / /^?/^ <br />A=cl:c2e'. reuse r.r.e u:! subrtucroli uiro O-.c C;r/ omets If aays -.eror: me Plaruuag Comeessioa .Meeting. Planning <br />Cjne^ssion Meeirsis ire feiii on ie -:rC Mor.Uiy ot eic.b T.cct.i. .Appi:cin'.s must be present it all sc.nrtlulecl <br />'evie-.rrr.eet:.iis ot uie P'.ieuir.g Commission ir.d C our.cil. If in ippiicint is unable to attend a sc.beduled meeting, <br />pieisc mijte irriegements to have an iumor.zed agen. attend m your place and advise the Buiiduig ii -oning Office <br />or '.his rhan^e pnor to the meetin;!