4.c) Waterman Application08/12/201.4 14:40 FAX 6123321529
RECEIVED
SDR CPA'S
File No.
AUG 12 2U'JALICATION FOR PLANNING AND ZONING REQUEST
City of Scandia, Minnesota
14727 209th Street North, Scandia, MN 55073
Phone 651/433.2274 Fax 651/433-5112 Web http://www,ci.scandia.mn.us
[a 002
Please read before completing: The City will not begin processing an application that is incomplete. Detailed submission
requirements may be found in the Scandia Development Code, available at the City office and website (www.ci.scandia.mn.us) and in
the checklist forms for the particular type of application. Application fees are due at the time of application and are not refundable.
1. Prope Lo (at9n: (street address, i ap
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2. Washington County Packe
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3. CompleteLegal Description: (attach iij ecessary)
4. Owner(s):
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Phone:
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Street Address: -1 l
E -Mail:
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City/ State: (YllCn I 5�1�
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5. Applicant/Contact Person:
Phone:
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Street Address (Mailing): Ljj � � 3Y Z s�
E -Mail:
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City/ State: S� i,� W k( � Did
Zip:
6. Requested Action(s): (check all that apply)
Yvariance — Administrative Permit
_ Amendment (Development Code)
_ variance Extension (type)
_ Amendment (Comp. Plan)
Conditional Use Permit (CUP) — Site Plan Review
— (hype)
_Subdivision, Minor
_ CUP Extension
Site Plan Modification
CUP/ Open Space Subdivision. —
_Subdivision, Preliminary Plat/Major
—
CUP/ Planned Unit Development — Site Plan Extension
_ Subdivision, Final Plat
_
Interim Use Permit (IUP) _ Sign (Permanent)
_ Environmental Review
W ettand Review
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08/12/2014 14:40 FAX 6123321529 SDK CPA'S [M 003
7. Brief Description of Request: (attach separate sheet if necessary)
GLS o J V
Date:
77
F/il/14
Apply7Signature(s)
Date:
8. Project Name:
I hereby apply for consideration of the above described request and declare that the information and materials submitted
with this application are complete and accurate. I understand that no application shall be considered complete unless
accompanied by fees as required by city ordinance. Applications for projects requiring more than one type of review
shall include the cumulative total of all application fees specified for each type of review. I understand that applicants
are required to reimburse the city for all out-of-pocket costs incurred for processing, reviewing and hearing the
application. These costs shall include, but are not limited to: parcel searches; publication and mailing of notices; review
by the city's engineering, planning and other consultants; legal costs, and recording fees. An escrow deposit to cover
these costs will be collected by the city at the time of application. The minimum escrow deposit shall be cumulative total
of all minimum escrow deposits for each type of review required for the project, unless reduced as provided for by
ordinance. The city may increase the amount of the required escrow deposit at any time if the city's costs are reasonably
expected to exceed the minimum amount. Any balance remaining after review is complete will be refunded to the
applicant. No interest is paid on escrow deposits.
PLEASE NOTE: If the fee owner is not the applicant, the applicant must provide written authorization by the fee
owner in order for this application to be considered complete.
Prope Fee wner Siguature(s)
Date:
77
F/il/14
Apply7Signature(s)
Date:
For City Use Only
Application Fees:
Escrow Deposit:
08/12/2014 14:41 FAX 6123321529 SDK CPI'S fC1j005
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