CUP Application FormPlanning Case No. CITY OF CHANHASSEN 7700 Market Boulevard – P.O. Box 147 Chanhassen, MN 55317 – (952) 227-1100 DEVELOPMENT REVIEW APPLICATION PLEASE PRINT Applicant Name and Address:
FMHC Corporation as agent for T-Mobile Central LLC 2901 Metro Drive, Suite 225 Bloomington, MN 55425 Contact: Kelly Swenseth Phone: 952-831-1043 Fax: 952-831-0623 Email: k swenseth@fmhc.com
Owner Name and Address: City of Chanhassen 7700 Market Boulevard Chanhassen, MN 55317 Contact:Laurie Hokkanen Phone: 952-27-1118 Fax: 952-227-1110 Email: l hokkanen@ci.chanhas sen. mn.us
NOTE: Consultation with City staff is required prior to submittal, including review of development plans Comprehensive Plan Amendment Temporary Sales Permit X Conditional Use Permit
(CUP) Vacation of Right-of-Way/Easements (VAC) Interim Use Permit (IUP) Variance (VAR) Non-conforming Use Permit Wetland Alteration Permit (WAP) Planned Unit Development* Zoning Appeal
Rezoning Zoning Ordinance Amendment Sign Permits Sign Plan Review Notification Sign – $200 (Cit?y to install and remove) x Site Plan Review (SPR)* X Escrow for Filing Fees/Attorney
Cost** -$50 CUP/SPR/VAC/VAR/WAP/Metes & Bounds -$450 Minor SUB Subdivision* TOTAL FEE $ 975.00 An additional fee of $3.00 per address within the public hearing notification area will
be invoiced to the applicant prior to the public hearing. *Sixteen (16) full-size folded copies of the plans must be submitted, including an 8½” X 11” reduced copy for each plan sheet
along with a digital copy in TIFF-Group 4 (*.tif) format. **Escrow will be required for other applications through the development contract. Building material samples must be submitted
with site plan reviews. NOTE: When multiple applications are processed, the appropriate fee shall be charged for each application.
G:\plan\forms\Development Review Application.DOC Rev. 1/08 PROJECT NA M E : T-Mobile Monopole at North Lotus Lake Park LOCATION: N orth Lotus Lake Park -295 Pleasant View Road, Chanhassen
MN 55317 LEGAL DESCRIPTION AND PID: PID: 25.5580020 Outlot B, Section: 01 Township: 116 Range: 023 Plat: 25558 NORTH LOTUS LAKE ADDITION TOTAL ACREAGE: Approximately two acres WETLANDS
PRESENT: YES X NO PRESENT ZONING: RSF -Single Family Residential REQUESTED ZONING: No Change Requested PRESENT LAND USE DESIGNATION: P a r k s /O pen Space REQUESTED LAND USE DESIGNATION:
No Change Requested REASON FOR REQUEST: Installation of an 80' monopole and appurtenant equipment to operate a telecommunucations facility. The proposed monopole will fill a coverage
gap in the residential area surrounding North Lotus Lake Park as requested by T-Mobile customers and to provide enhanced digital services, including E-911. The monopole will replace
the existing light pole on the Southwe st corner of the ice rink. The lights will be removed from the existing pole and remounted at the same height on theproposed monopole. FOR SITE
PLAN REVIEW: Include number of existing employees: None and new employees: None 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, you should confer with the Planning Department to determine the specific
ordinance and procedural requirements applicable to your application. A determination of completeness of the application shall be made within 15 business days of application submittal.
A written notice of application deficiencies shall be mailed to the applicant within 15 business days of application. This is to certify that I am making application for the described
action by the City and that I am responsible for complying with all City requirements with regard to this request. 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 have attached a copy of proof of ownership (either copy of Owner's Duplicate Certificate of Title,
Abstract of Title or purchase agreement), or I am the authorized person to make this application and the fee owner has also signed 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. The documents and information I have submitted are true and correct to the best of my knowledge. September 18, 2008
Signature of Applicant Date Signature of Fee Owner Date