2004-10-12 Zoning Request ApplicationFROM : CITY OF ALBERTVILLE FAX NO. : 7634973210 Oct. it 2004 12:43PM P2
CITY OF ALBERTVILLE ■ ZONING REQUEST APPLICATION
5975 Main Avenue NE Case No: a
P.O. Box 9 Base Fee:
Albertville, MN 55301-0009 EscrowAmt: Pd.5
(612) 497-3384 fax(612) 497-3210 Date Filed: 1 u —( a q
Please read carefully and answer all questions thoroughly. Only complete applications will be accepted
after validation by the City Clerk and prior to acceptance of required processing fees/deposits.
Street Location of Property: IS 7 f � S
Legal Description of Property
(Attach additional sheet if necessary): G�c-C r 4D 4 A
Owner: Name:
A N IJ
Address: / L/297� JTeul-e e
City: State: ✓ 17J ._ . _._ ZIP:, %
Telephone (1iomei;3H" 1C1 " .�C� (Busincss):'7 1'n l' (Fax):
Applicant (If other than owner
Owner: Name: r ,
Address:
161
City: �PQja rx _ State: Zip:
Telephone (Home):'--- (Business): � � .. Ye" �L VT 92 3 (Fax):
Type of Request(s):
✓ Site and Building Plan Review
Minor Subdivision/Consolidation
Preliminary Plat
_ Final Plat
Comprehensive Plan or
Ordinance Amendment
Description of Request(s):
Rezoning
Variance
Conditional Use Permit
Interim Use Permit
Planned Unit Development
Other
FROM : CITY OF ALBERTVILLE FAX NO. : 7634973210 Oct. it 2004 12:43PM P3
4 - X
Page Two, City of Albertville Planning/zoning Application
Reason Why Request Should Be Granted: /�S'� _ ��� ey �—'
I .�__—
]Existing Us of the Property / Nature of Facility or Business: /
If a request for a planning/zoning action on the subject site or any part thereof has been previously sought,
please describe it below:
What?
When? !V 0 Project Name, if applicable: 104 6< / �10
I hereby apply for the above consideration and declare that the information and materials submitted with this application are
in compliance with City Ordinance and Policy Requirements and are complete and accurate to the best of my knrnvledge.
I understand that the application will he processed for the next available meeting agenda after review of the information
submitted to determine if any other data is needed and after completion of a staff report.
I understand that all City incurred professional fees and expenses associated with the processing of this request are the
responsibility of the property owner and/or applicant and should he promptly pdd. If payment is not received from the
applicant. the property owner acknowledges and agrees to be responsible, jor the unpaid fee balance either by direct payment
or a xpecial assessment against the property.
(If the property fee owner is not the applicant, the applicant must provide written authorization by the owner to mane
application)
Sissy (60) Day Waiver; The City hereby notifies tke applicant that development review may not be completed within the
required 60 days due to public hearing requirements and agency review; therefeM the City is taking an automatic 60-day
extension for development review Development review b_ a completed w0hin 120 days anless the applicant approvex
additional reviewextendoras -)�„ 7 ;
Signature(s) of Owner(s):
Signature(s) of Applicant(s):
Approved Denied by the Planning Commission on: (Date)
Approved Denied _ __ by the City Council on: (Dale)
Date/b — / 0 - C-� '�/
Date:
Datc:
Date:
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