4.d) Olson Application materialsFile No. 9 0 I — 015
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.mn.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 (www.ci.scandia.mn.usl 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, if applicable)
&W—
2. Washington County Parcel ID:
P35, O ao. Cw
,
3. Complete Legal Desf�ription: (attach if necessary)
4. ner s :
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Phone:
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Sly 17
(b)61R-91-3- 735z>
StreetAddressvt'�e-?'. a,�55
E-Mail:�xj�(�1�✓®C01716W-4� f.
City/ State://,/ -,',4d- /d('�A fYf�/
Zip:01o?7
S. Applican Contac Person:
Phone:
(h) G�/- 3c, 3-` V;K3
(b)
Street Address (Mailing):,�5 70Z� AQ'.
E-Mail:/W�,6a ,,,��
City/ State: G ' 5e CiZip:
t� 3 p/3
6. Requested Action(s): (check all that apply)
variance Administrative Permit
Amendment (Development Code)
— Variance Extension (type)
_Amendment (Comp. Plan)
— Conditional Use Permit (CUP) Site Plan Review
(type)
—Subdivision, Minor
_CUP Extension
CUP/ Open Space Subdivision. — Site Plan Modification
Subdivision, Preliminary Plat/Major
CUP/ Planned Unit Development — Site Plan Extension
_ Subdivision, Final Plat
Interim Use Permit (IUP) Sign (Permanent)
Environmental Review
Wetland Review
7. Br%f Description of Request: (attach separate sheet if necessary)
Date:
Applicant e )
Date:
i
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8. Project Name:
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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 Owner Signature(s)
Date:
Applicant e )
Date:
For City Use Only PAID
Application Fees: tt 50 MAY 13 2014
Escrow Deposit: Y 2�
CITY OF SCANDIA
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