Application 6-17-05
Planning Case No. 0 S -~
CITY OF CHANHASSEN
7700 Market Boulevard - P.O. Box 147
Chanhassen, MN 55317 - (952) 227-1100
CITY OF CHANHASSEN
RECEIVED
DEVELOPMENT REVIEW APPLICATION
JUN 1 7 2005
~NHASSEN PLANNING OEPT
eM..
Contact: '1vt /J}f ru (Ut -e
Phone: 410 -it f ~ I Fax:
Email:
Comprehensive Plan Amendment
Temporary Sales Permit
Conditional Use Permit
Vacation of Right-of-Way/Easements
Interim Use Permit
Variance
Non-conforming Use Permit
X Wetland Alteration Permit
Planned Unit Development*
Zoning Appeal
Rezoning
Zoning Ordinance Amendment
Sign Permits
Sign Plan Review
Notification Sign** - $75 + $100 Damage Deposit
Subdivision*
X escrow for Filing Fees/Attorney Cost***
~,,$qO CUP/SPRN ACN AR/W AP/Metes & Bounds
- $450 Minor SUB
TOTAL FEE $ ;. 00 . tJO
Site Plan Review*
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.
* Twenty-six (26) full-size folded copies of the plans must be submitted, including an 8W' X 11" reduced copy for each plan sheet
along with a diqital COpy in TIFF-Group 4 (*.tif) format.
** Applicant to obtain notification sign from City of Chanhassen Public Works at 1591 Park Road and install upon submittal of
completed application. $100 damage deposit to be refunded to applicant when sign is returned following City Council approval.
*** 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.
PROJECT NAME: 1?(Jtl+ 7)0 c.k
LOCATION: /1, L/ Lfo Fir!- p~ I ~q~~
LEGAL DESCRIPTION: I-?l + q I f3 / D d.L II h>? ili ge-
, - J
C/JVf!..t COlM-t~ I m,'NM-Sof~
TOTAL ACREAGE: Lf?;) q 77 S,t:,. f-J-.
X YES
WETLANDS PRESENT:
NO
PRESENT ZONING: .
REQUESTED ZONING:
PRESENT LAND USE DESIGNATION:
REASON FOR REQUEST:
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REQUESTED LAND USE DESIGNATION:
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~ ~ t:e t; S o71i-v Lo fu.s L-c:Jce .
4 bod dock
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.
~M-~
If !?!05
Date
Signature of Applicant
~~
p6rgnature of Fee 0 er
b~~
Date
"-.
G:\plan\forms\Development Review Application.DOC
Rev. 4/05
FORLGUUSEONLY:
Determination for Part 1:
o No WCA Jurisdiction
o Exempt: No. _ (per MN Rule 8420.0122)
o No Loss: _ (A,B,. . .G, per MN Rule 8420.0220)
o Replacement required - applicant must complete Part II
COMPLETE THE SECTION BELOW ONLY IF REPLACEMENT IS NOT REOUIRED:
Application is (check one): 0 Approved DApproved with conditions (conditions attached)
o Denied
Comments/Findings:
LGU official signature
Date
Name and Title
For Agricultural and Drainage exemptions (MN Rule 8420.0122 Subps. 1 and 2B), LGU has received proof of recording of restrictions
(per MN Rule 8420.0115):
County where recorded
Date
Document # assigned by recorder
LGU official signature
Date
Minnesota Local/State/Federal Application Forms for Water/Wetland Projects
Page 3
NA-026620-03B (V.2.02 for MS WORD) 09/01/04
Minnesota Local/State/Federal A lication Form for Water/Wetland Pro.ects
For Internal Use Only
A lication No. Field Office Code Date Initial A lication Received Date initial A
PART I: BASIC APPLICATION
"See HELP" directs you to important additional information and assistance in Instructions, Page 1.
1. LANDOWNEIYAPPLICANT CONT~CT INFORMATION (See Help 1)
Name:DAVI'cL ~tuA~c9--1.-M(Ul1 ti.t(~e: '-170 - t,f&j
comPletemailingaddress:&LfLfOM(!~tJ.fo.:ft.- ~(j~eu- N Ai
lA. AUTHORIZED AGENT (See Help 1A~y if applicable; an agent is not required)
Name: Phone:
Complete mailing address:
2. NAME, TYPE AND SIZE OF PUBLIC WATERS or WETLANDS IMPACTED (Attach Additional Project Area sheets if needed)
Name or I.D. # of Waters Impacted (if applicable; if known):
(Check all that apply): OLake ORiver OWetland type 0 lOlL 0 2 0 3 04 0 5 0 6 0 7 0 8
Indicate size of entire lake or wetland (check one): 0 Less than 10 acres (indicate size: ) 010 to 40 acres 0 Greater than 40 acres
3. PROJECT LOCATION (Information can be found on property tax statement, property title or title insurance):
Project street address: Fire #: City (if applicable):
l.,4 Section: Section: Township #: Range #: County: (!, ~~V.e r
Lot #: ~ Block: I Subdivision:f(;)( ~q,e-. Watershed (name or #)
Attach a simple site locator map. If needed, include on the map written directions to the site from a known location or landmark, and
provide distances from known locations. Label the sheet SITE LOCATOR MAP.
4. TYP't?~~10JD;~ IZcribo ;~7:/pro(K>i: ;;~ Alt;Ie!:. p~o~;; ;J'~11t at VOSS aMI ~ 5
5. PROJECT PURPOSE, DESCRIPTION AND DIMENSIONS: Describe what you plan to do and why it is needed, how you plan to
construct the project with dimensions (length, width, depth), area of impact, and when you propose to construct the project. This is the
most important part of your application. See HELP 5 before completing this section; see What To Include on Plans (Instructions,
page I). Attach PROJECT DESCRIPTION sheet.
Footprint of project:
acres or
square feet drained, filled or excavated. ~ () fl f!.-..
6. PROJECT ALTERNATIVES: What alternatives to this proposed project have you considered that would avoid or minimize impacts
to wetlands or waters? List at least TWO additional alternatives to your project in Section 5 that avoid wetlands (one of which may be "no
build" or "do nothing"), and explain why you chose to pursue the option described in this application over these alternatives. Attach
PROJECT ALTERNATIVES sheet if needed.
nbl1f:-
7. ADJOINING PROPERTY OWNERS: For projects that impact more than 10,000 square feet of water or wetlands, list the complete
mailing addresses of adjacent property owners on an attached separate sheet. (See HELP 7)
8. PORTION OF WORK COMPLETED: Is any portion of the work in wetland or water areas already completed? 0 Y es ~No. If
yes, describe the completed work on a separate sheet of paper labeled WORK ALREADY COMPLETED. (See HELP 8)
9. STATUS OF OTHER APPROVALS: List any other permits, reviews or approvals related to this proposed project that are either pending or
have already been approved or denied on a separate attached sheet. See HELP 9. AD n e-
10. I am applying for state and local authorization to conduct the work described in this application. I am familiar with the information
contained in this application. To the best of my knowledge and belief, all information in Part I is true, complete, and accurate. I possess
he authority to undertak t e WQ k desc' d, or I am acting as the duly authorized agent of the applicant.
l
(/ J& Jo~
I r
Date
Signature of agent (if applicable)
Date
,/.~
Signal!!fe.ofci"pplicant (Landowner)
This block must be signed by the person who desires to undertake the proposed activity and has the necessary property rights to do so. If only the Agent has signed,
please attach a separate sheet signed by the landowner, giving necessary authorization to the Agent.
Minnesota Local/State/Federal Application Forms for Water/Wetland Projects
Page 1
APPLICA nON FOR DEPARTMENT OF THE ARMY PERMIT (33 CFR 325) OMB APPROVAL NO. 0710-003 Expires Dec 31, 2004
The public burden for this collection of information is estimated to average 10 hours per response, although the majority of applications should require 5 hours or less. TIlis includes
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington
Headquarters Service Directorate of Information Operations and Reports, ]2]5 Jefferson Davis Highway, Suite 1204, Arlington, V A 22202-4302; and to the Office of Management
and Budget, Paperwork Reduction Project (0710-0003), Washington, DC 20503. Respondents should be aWare that notwithstanding any other provision of law, no person shall be
subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to
either of these addresses. Completed applications must be submitted to the District engineer having jurisdiction over the location of the proposed activity.
PRIVACY ACT STATEMENT: Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research and
Sanctuaries Act, 33 USC 1413, Section 103. Principal purpose: Information provided on this form will be used in evaluating the application for a permit. Routine uses: TIlis
information may be shared with the Department of Justice and other Federal, state, and local government agencies. Submission of requested information is voluntary; however, if
information is not provided, the permit application cannot be evaluated nor can a permit be issued.
ITEMS 1 THROUGH 4 TO BE FILLED IN BY THE CORPS
1. APPLICATION NO.
2. FIELD OFFICE CODE
3. DATE RECEIVED
4. DATE APPLICATION COMPLETED
YOU DO NOTNEED TO COMPLETE ITEMS 6-10 and 12-25 in the SHADED AREAS.
All applicants must complete non-shaded items 5 and 26. If an agent is used, also complete items 8 and 11. This optional Federal form is valid
for use only when included as art of this entire state a lication acket.
5. APPLICANT'S ry.ME /J
Man' (OHtt- t Cdr1JL
8. AUTHORIZED AGENT'S NAME AND TITLE (an agent is not required)
11. STATEMENT OF AUTHORIZATION (ifapplicable; complete only ifauthorizing an agent)
I hereby authorize to act o~ my b;)4f as my agent in the processing of this application and to furnish, upon request,
supplemental information in su~~li~1 ~ _
APPLICANT'S SIGNATURE: (p /&/0 ~
&/&(06
ignature of applicant Date Signature of agent (if any) Date
The application must be signed by the person who desires to undertake the proposed activity (applicant), or it may be signed by a duly authorized agent if
the statement in Block I I has been filled out and signed. 18 V.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any
department or agency of the United States knowingly and willfully falsifies, conceals, or covers up with any trick, scheme, or disguises a material fact or
makes any false, fictitious or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false,
fictitious or fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both.
ENG FORM 4345, Jul97 EDITION OF FEB 94 IS OBSOLETE. (Proponent: CECW-OR)
Minnesota Local/State/Federal Application Forms for Water/Wetland Projects
Page 2