2009-01-10 Administrative Permit for Land FillingA�Ib.
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5975 Main Ave NE
P.O. Box 9
Albertville, MN 55301-0009
(763) 497-3384 fax (763) 497-3210
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• ADMINISTRATIVE PERMIT APPLICATION
Case No: O oq ' OA
Base Fee: na
Escrow Amt: �Do Pd.
Date Filed:
Please read carefully and answer all questions thoroughly. Only complete applications willbe
accepted after validation by the City Clerk and prior to acceptance of required processing
fees/deposits.
Type of Request(s):
Essential Services (> 33kv)
Home Occupation
Land Excavation, Grading
Land Filling
SiHFI- MELTING DATE:
PROJECT PLANS DUE DATE:
Address of Subject Propi
Name of Business:
Swimming Pool
Temporary Outdoor Seasonal Sales
Other
PLANNING COMMISSION DATE:
CITY COUNCIL DATE:
Legal Description of Property (attach additional sheet if necessary):
Lot: Block
Subdivision: _ PID#
Owner: Name., / ,
Address. t i
City.
Telephone (Home).
Applicant (If other than the owner):
Owner: Name.
Address.
City.
Telephone (Home).
Description of Requests
�.h
Plat#
State. :17AI Zip. S 3 �'
(Business) 43 �Vj � 3 (Fax)
State.
(Business)
a
�E7r 2Si�'fvrA� �i��
Zip..
(Fax)
Description of Request(s):
EFFECTS OF THE PROPOSED USE: List impacts the proposed use will have on property in
the vicinity, including, but not limited to traffic, noise, li ht, smoke/odor, parking, and describe
th steps taken to miti ate or eliminate the impacts:�� jf mho
Kri l I awFlnQsS Mhur<
Reason Why Request Should Be Granted: �� Ai j ( zed; r d/ j com �1�
a�
Existing Use of the Property / Nature of Facility or Business:,
If a request for planning/zoning action on the subject site or any part thereof has been
previously sought, please describe it below:
What?
When?
Project Name, if applicable:
co i`h
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 knowledge.
I understand that the application will be 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.
l 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 be promptly paid. if payment is not received from the applicant, the property owner
acknowledges and agrees to be responsible for the unpaid fee balance either by direct payment
or a special assessment against the property. If the property fee owner is not the applicant, the
applicant must provide written authorization by the owner to make application.
Signature(s) of Owner(s): ` ,1�� Date: i 'r-
Date:
Signature of Applicant(s): Date:
Date:
Approved _ Deniedby the Planning Commission on: Date:
Approved Denied by the City Council on: Date:
Distribution
City Planner: Building/Zoning Official: 10 1 Fire Dept.:
City Enaineer: 1 Public Work/Pa�rr^kss: 01C Other: '--�(` -