Appeal 24-07 application*crTYorcr,NuAssxil
APPLICATION FOR DEVELOPMENT REVIEW
PC Date CC Date:60-Oay Review Date
Section 1: Application Type (check all that apply)
(Refet to the apNopiate Application Checklist fot requirccl submiftal inlomafion that husl accompany lhis application)
! Comprehensive Plan Amendment......................... $600
E Conditional Use Permit (CUP)
n Single-Family Residence ................................ $325! All Others....... .................... $500
E lnterim Use Permit (lUP)
! ln conjunction with Single-Family Residence.. $325
! Subdivision (SUB)
E Create 3lots or |ess........
! Create over 3 lots .$1000 +( lots)
n Metes & Bounds (2 lots)
n Consolidate Lots............
E Administrative Subd. (Line Adjustment)
n Final Plat + S15 per |ot........
...... $50o
$15 per lo
....... $300
....... $150
....... $150
..... $700-
.. $150
.. $275
$200
$500
n At others.........
E Rezoning (REz)
trtrfl Att others................
n Sign Plan Review..........
E Site Plan Review (SPR)
Planned Unit Development (PUD) ..........
l\.4inor Amendment to existing PUD.........
. $150
E Administrative
! Commercial/lndustrial Districts'
..... ..... sl00
........... $500
Plus $10 per 1,000 square feet of building area:( thousand square feet)
'lnclude number of 9!Sl&g employees:
*(lncludes $450 escrow for attorney costs)
'Additional escrow may be required for other applications
thrcugh the development contract.
n Vacation of Easements/Right-of-way (VAC)........ $3OO
(Additional recording fees may apply)
n Variance (VAR).................................................... $2OO
E Wetiand Alteration Permit (WAP)
! Single-Family Residence.................! Att otners.......
I nppeat of Administrative Decision..........
E Zoning Ordinance Amendment (ZOA)...
$200
.. $500
$750
$100
$500
tr 'lnclude number ol !g!y employees
Residential Districts....................$500
Plus $5 per dwelling unit ( units)
AqIE: When nulliple applications are processed concunenuy, the appropriate fee shall ba charged for each application,
E Notification Sign (city to install and remove) .....
tr
tr
Property Owners' List within 500' (City to generate after pre application meeting) .................... .$3 per address
L addresses)
Escrow for Recording Documents (check allthat apply)......................... ................ $ per document
E Conditional Use Permit - $50 Ellnterim Use Permit $50 E Site Plan Agreement - $85
E Wetland Alteration Permit - $50 E Easements L easements) $85 E Vacation - $85
E Variance - $50 E Metes & Bounds Sub (2 deeds) $259 [Deeds-$100
TOTAL FEE:
Section 2: Required lnformation
Description of Proposal:
Property Address or Location
Parcel #:Legal Description
Total Acreag ", 4, /3 Wetlands Present?
Present Zoning: --f 6tr
Present Land Use Designation Requested Land Use Designation:
! ves [,tto
Requested Zoning:
E, Check box if separate narrative is attached
COMMUNITY OEVELOPMENT DEPARTMENT
Planning Division - 7700 Market Boulevard
lvlailing Address - P.O. Box 147, Chanhassen, MN 55317
Phone: (9521 ?27-1 100 / Fax: (952\ 227-1110
SubmittalDate:
6e5/ Tero^t La. N ?-
Existing Use of Property:
Section 3: Property Owner and Applicant lnformation
APPLICANT OTHER THAN PROPERTY OWNER: ln signing this application, l, as applicant, represent to have obtained
authorization from the property owner to file this application. I agree to be bound by conditions of approval, subject only to
the right to object at the hearings on the application or during the appeal period. lf this application has not been signed by
the property owner, I have attached separate documentation of full legal capacity to file the application. This application
should be processed in my name and I am the party whom the City should contact regarding any matter pertaining to this
application. I will keep myself informed of the deadlines for submission of material and the progress of this application. I
further understand that additional fees may be charged for consulting fees, feasibility studies, etc. with an estimate prior to
any authorization to proceed with the study. I certify that the informalion and exhibits submitted are true and correct.
N".", 6e14d d -9Ior-Y contact:L2tt Te-tov Lqu*-Phone lga- q)s-9,'r q
City/State/Zip:nh ,(S Cell
FaxEmailCo
Date: O b a1,o
PROPERry OWNER: ln signing this application, l, as property owner, have full legal capacity to, and hereby do,
authorize the filing of this application. I understand that conditions of approval are binding and agree to be bound by those
conditions, subject only to the right to oblect at the hearings or during the appeal periods. I will keep myself informed of
the deadlines for submission of material and the progress of this application. I further understand that additional fees may
be charged for consulting fees, feasibility studies, etc. with an estimate prior to any authorization to proceed with the
study. I certify that the information and exhibits submitted are true and correct.
Name Contact
Phone:Address
City/State/Zip:
Email:
Cell:
Fax;
DateSignature
This application must be completed in full and be typewritten or clearly printed and must be accompanied by all
information and plans required by applicable City Ordinance provisions. Before filing this application, refer to the
appropriate Application Checklist and confer with the Planning Department to determine the specific ordinance and
applicable procedural requirements.
A determination of completeness of the application shall be made within 15 business days of application submittal. A
written nolice of application deficiencies shall be mailed to the applicant within 15 business days of application.
PROJECT ENGINEER (if applicable)
Name:Contact
Phone:
Cell
Fax
Who should receive copies of staff reports?'Other Contact lnformation:
E Property Owner Email
El Appticant Email
! Engineer Email
E Otfref Email
Name:
Address
City/State/Zip
Email:
INSTRUCTIONS TO APPLICANT Complete all necessary form flelds, then select SAVE FORM to save a copy to your
Section 4: Notification lnformation
c ago
device. PRINT FORM and deliverto city along with required documents and payment. SUBMIT FORM to send a digital
copy to the city for processing.
Address:
Signature:
Add.o""'
City/State/Zip:
Email: