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M O '-“S <br />required submittals <br />1 Completed Application Form. <br />------------- _ _________________ <br />2. <br />3. <br />- 'pTp=^“otI>“« Lis. of owners within 350', lahols «d pU. wp (you <br />- murt ^..in to list, label. «d map from Hennepin County DeparSmen. of <br />Finance. A-603. Government Center, 348-3271). <br />4. <br />5. <br />6. <br />7. <br />8. <br />o <br />clXt. oy = • "f" <br />deseriplion to applieation if not included on required .^ey. <br />- survey (elating «td proposed enntours) if land aUeratton. tnvolve <br />' to "am« (t“L marital statu.) of all parsons with an interesUn <br />- ptoperty. TOs would ioelude name(.) of applicantfs) tf not current ownet(s). <br />roMtruction plan, if applicable (sec siafT for requirements). , <br />- ArrSndum to to applieaUon. please attach a separate hst of «ty other <br />persons you wish notified of this application. <br />S will require to scale drawings of all document, plans, eic. Ir. oe <br />submitted.) <br />The APPlio«.t and Property Owner must sign .hi, application. Plctsc remember to. your <br />ISltoto" compU if llttt »»»ve infom»tion no. been tnc.wled. <br />certification by Clerical Department to. Land Us. Appli^io- Is eomplere. <br />Initials of Clerical Staff.,^----------—- ^ <br />APPLICANT'S SIGNATURE f^rmniion reouired or requested by the ironing <br />The applicant hereby agrees ^ ^ ^ot covered by original fee payment) <br />Administrator, agrees to pay addtlional ^ application, and certifies that the <br />and/or unusual «P'«« , ofinformation supplied is Irue^d eoirepMq ttsejes oi <br />Applicant's signature ./tjs <br />'P/^m rn 1 I nn « <br />Date <br />•rom Dillon# Orono Development# DLC <br />OWNER'S SIGNATURE application and furtlier aulhmireJ <br />Tho owner hereby actamw. ges d S . ^ ^ contmlssion member., <br />“■rc"" ......-r <br />Owner'.s signature <br />Dote I II r>7. <br />\ V£Jc:^y/ —^ - — f------------------- <br />Ted Chclatianaon. Adam Smith Company on Mcci'"S <br />Applic.nl me.l h.Ce .« mb"'!"*'' i”’-"" VT M.nU« eV .TlL'n^^ Appli‘«« own b' P"*""/; <br />PUnnlnt Commi>.i°n ."d Coencl If .0 «Ppl'C»o> ^ ''"“b'' ^ <br />.11 «h.du1.d rc.l..Y ,e h..c .» .olherirra .«rol eumd b- r"' <br />J