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PBBSSNT OSB OF PROPERTYPresent Zoning District <br />Present Use of Property Residential <br />Other fspecify) Church <br />SBSCRZPTIOM OP REQUEST <br />Describe re<^uest in detail:Constr*-crior. cf a 1_0' antenna tcwer and the location <br />of a 12* X 30*' prefabricated equipiaent for a U5 West - New Vecnor <br />Cellular phone antenna, - - - - - - - - - - - - - - - - - -- - - <br />REQUIRED SUBMITTALS <br />1. Completed Application Fom. <br />Certified Property Owners List of owners within 350’ (you can obtain <br />this list from Hennepin County Department of Finance A-603 Government <br />Center 348-3271). <br />Plat Map. , <br />Certificate of survey (signed by a licenset surveyor). <br />Topographic survey (existing and proposed contours) if j.an <br />alterations involve changes in elevation (grades). <br />Construction plan, if applicable (see staff for requirements). ^ <br />As an addend’un to this application, please attach a separate «ist or <br />any other persons you wish notifiec. of this applicat-i-on. <br />YOU ARE REQUIRED TO SUPPLY 30 COPIES OP LARGE DOCUMENTS OR <br />A WORKING COPY (ll" X 17" OR SMALLER) FOR ALL DOCUMENTS SUBMITTED. <br />The applicant and Property Owner must sign this application. Please <br />remember that your application is net complete if the above information has <br />not been included. <br />Certification by Clerical Department that Land Use Application is complete. <br />Initials of Clerical Staff;._ _ _ _ _ _ ___ _ _ _ _ _ _ _ _ _ _ _ _Date- - - - - - - - - - - <br />2. <br />3. <br />4. <br />5. <br />6. <br />7, <br />APPLICANT* S SIGNATURE ^ ^ <br />The applicant hereby agrees to provide all inrormation required or <br />requested by the Zoning Administrator, agrees to pay additional fees (staff <br />time not covered by original fee payment) and/or unusual expenses incurred <br />in review of -his applicatiqn, and certifies that the information supplied <br />is true and correct to the at MT^h» knowledq^. <br />(Ay//L KB^y 0...Applicant’s signature <br />(for USIJEST New Vector) <br />552^aerTe^y acknowledges and agrees <br />Authorized reasonable <br />agents# commission <br />investigation an <br />entry onto the pro <br />ambers# and, <br />LiOirsif thi <br />uncil members <br />Owner's signature I <br />est. <br />Date <br />Office of this change prior to the meeting.