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reqlired submittals <br />1. Completed Application Fonn. <br />Describe request in detail. <br />Certifwd Property OwnerS-lkiSt of p^wprs ,wjiluii^5(F* (ypu can obtain this list from <br />Hennepin Ccwnty Department of Finance, A-603, Govcmme it Center, 348-3271). <br />4. Plat Map <br />2. <br />3. <br />Certificate of Survey (signed by a licensed surveyor) - refer to handout for survey <br />c^dnnation. <br />ti * **' XttaJii legal description to application if not;^udcd,on,required-survey. ; • <br />Hit m • • ___J_______________1 ______\ -/-i****? »_____i • I • <br />5 Cei <br />iT ‘ • A-—.• . •v* ; • •; • irtfpmiation. <br />• «L .ei -*» • * •• ’ <br />7‘V‘* • V Topographic suTvtyv'^existing aiKl,|vc?po:sed; cqnjjC^^V-if• land alterations involve <br />As an addendum to this application, please attach a separate list of any other persons <br />you wish notified of thi^^pplicatiori. _ <br />YOU ARE Pi^QUIRED TO SUPPLY 30 COPIES OF LARGE DOCL^IENTS OR COPY <br />FOR REPRODUCTION (11" X 17" OR SMALLER) FOR ALL DOCUMENTS <br />SL^BMITTED. (Staff v ill require to cale drawings of all documents, plans, etc. to be <br />submitted.) <br />The Applicant and Property Owner must sign this application. Please rememher that your <br />application is not complete if the above information has not been included. <br />Cenification by Clerical Department that Land Use Application is complete. <br />Initials of Clerical Staff;___________________________------------------------------—-------- <br />APPLICANT’S SIGNATURE u ^ <br />The applicant hereby agrees to provide all information required or requested by the ^oning <br />Administrator, agrees to pay additional fees (staff time not covered by original fee payment) <br />and/or unusual expenses incurrecTfe review of this application, and certifies that the information <br />sup^n . J is true and correct t/Lh(t best of his/her knowledge. <br />Applicant ’s signature r,Me sefir. <br />(?<5- PPU/^7^ <br />SIGNATUKb 4 K1 <br />The owner hereby acknowledges and agrees to this application and fu^er authorize reasona e <br />entry ci.iO the property' by City staff, consultants, agents, commission members, an ounci <br />members for purposes of investigation and verification of this request. <br />Owner’s signature Date <br />of this change prior to the meeting. - '