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cm OF OBCNO, MMESOTA <br />Conditional Use and Variance Applicati <br />MC554 <br />UOCWION OT FRDPOSAL (or property) <br />fffr —' y A\ TAddress <br />Legal Description <br />APPLIC/W <br />Name , - —- - . <br />OWNER C.^\-^ <br />Address <br />type of request <br />Conational Use <br />Variance <br />Wetlands Variance <br />RiprapPhone t HlZm ofi <br />, ^ ^1 FOR OFFICIAL Uffi CNLY <br />I Hi 5 qyo? 1 Council Acuon <br />Hardships to Property (Your reasons <br />for requesting this Variance or Conditional Use Fernit <br />lowcil > <br />(x‘fT, <br />jj^OHUAL 1®CESSARI for applicaticn <br />\ (Most be submitted 1 v»e^ <br />- C^#*——.... ■1 Anolication conpleted owners wittoV ^t»tap Section from Hennepin County <br />V. ailveHsi'etdi ^ S^R..' 5. $30.0v Fee <br />5r*s, List of <br />(150 ft.) <br />* ir_o£- <br />Date <br />Signature