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Case No: --- <br />VILLAGE OF OR0140 <br />Crystal Bay, Minnesota Jll�-18 <br />AID <br />(Complete in Duplicate) G DUO <br />v <br />his form to be used in all applic.'ions for special use permits and for <br />exoning, dividing or eonsolidat-in,;:arcels of land, vacating streets, aClwi-s <br />-nd v.iria ces. <br />ype o,_ Application _ (/({iY!.�!2C� _. ^_-- Datc_—_- <br />Ivner of Property: Name_/-"4/W g_ �11��on . Phonc No. <br />Address-kf..5t. <br />-pplitaint (othe•i than awner.) . Naiie h, ;s;. tic <br />Address_ _ <br />Relatior.ship to Cwner <br />'.,and ?lsn.icr: Name <br />Phone No. <br />Phone No. _ <br />aubdi•.r'idec: Name. Phone No. <br />:•,ocation (How we find :01)�— tUro_IL__ (n -cba r KJ 4 <br />-egal Des:rin;'?.-i.� 5 <br />- r ¢1e Cwnezlp '3 <br />?;ate Acquired_ i 1.._ w A. -ea (sq. ft.) Separate Ownp.-sn:;p --_ <br />Date of last Division of this PTOpe,ty <br />Do you own any a� joi.ni.ag propart--, //o- <br />J'.ction Requested Y�r/� n O h 'set--bdc-le ro �, <br />._J�oo?4__ c19 C�._Go r�1� k _ <br />..�ir gnaturo of Appiiciin :: <br />_RECORD OF ACTION TAKEN <br />Da*.: Action, D / <br />nspection Dept. 7�7/r ��� _/d+� /_8� '•s <br />,.dm:inistrx.or: <br />iilage C,)vncil: 210-0,6 d._� --- ------ -- - - _ <br />tillage Enginc er —.---_ ----- —__-- _ - _ <br />tillage Attorney: ------.•_-- -.__.— __-----__—__.--..._---.__-- <br />I'lanninR Coxmiss::on: <br />Village Council: <br />Permit Is:.ued: I,att <br />