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4.b Hartley application to amend bakken dev agmtU File Nox-2 I ] -U 3 Q APPLICATION 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.nui.us 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 (wNvw.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. Property Location: (street address, Y'applicable) )(K)(- 2. Washington County Parcel D: as, & 3Q .12 00 QS 3. Complete Legal Description: (attach if necessary) Z- 611ek 4. Owner(s) :e,ry !-f--f/cy Street Address: Go�rl 2 �$ � �1 City/ State: bV�,owx,t,,,�, , IM 4, _iJ 5. Applicant/Contact Person: Street Address (Mailing): c�� C`�a m T–r City/ State: n+ 6. Requested Action(s): (check all that apply) ~ Variance Variance Extension Conditional Use Permit (CUP) CUP Extension CUP/ Open Space Subdivision. CUP/ Planned Unit Development Interim Use Permit (iUP) Annual Operators Permit Administrative Permit (hype) Site Plan Review (type) XSite Plan Modification Site Plan Extension Sign (Permanent) Phone: (h) q 3 7 5-73 7 717 (b) ? 7 S- &-7 E -Mail: �rc�v�rJ �I wrrw,rt �f�ynar`�: �,I Zip:5 5 6"f 2 - Phone: Phone: 6 j-3trfl a 7L (h) (b) E -Mail: Zip: s5d;�5 Amendment (Development Code) Amendment (Comp. Plan) Subdivision, Minor Subdivision, Preliminary Plat/Major Subdivision, Final Plat Environmental Review Wetland Review 7. Brief Description of Request: (attach separate sheet if necessary; include Variance Rationale if necessary) �T iJMEliL_.I ..�� I�•�3r�i PQ C 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. Property Fee er Signature(s) Date: pplicant Sign Date: m For City Use Only PAID Application Fees:DT 2 9 2018 Escrow Deposit: o f f! 0d 0 r • CITY Of SCANDIA