Development Review ApplicationR-}J>-13
COMTIIUNITY DEVELOPMENT DEPARTMENT
Planning Division - 7700 Market Boulevard
Mailing Address - P.O. Box 147, Chanhassen, MN 55317
Phone: (952) 227 -1 100 / Fax: (952) 227-LLLO CITY OT CIIAI,IHASSII'I
APPLICATION FOR DEVELOPMENT REVIEW
r I,,\el 6O-Day Revi6r/ Daie:l>/ eq \aa
Section 1: Application Type (check all that apply)
(Retq to tE qpropiale Applicalim Cl,€cklin to( re,quited su&n al inlqnation tlat n s *canpany this aqdicatbl)
E Comprehensive Plan Amendment......................... $600
! Minor MUSA line for failing on-site sewers ..... $100
E Conditional Use Permit (CUP)
E Single-Family Residence .I ntt ohers
E tnterim Use Permit (lUP)
s300
fl Create over 3 lots .......................$600 + $15 per lot( lots)
$32s
$/25
Metes & Bounds (2 lots)..................................$300
fl Lot Line Adjustment
E Final P|at.......
(hcludes 9450 escrofl for atrorney c6ts)*
,Additional escrow may be requa,ed lor o(her applicatjors
through the development contrd.
$750 E vacation of Easementsi/Right-of-way (vAc)........ $300
$100 Gdditional recordiog tues may apply)
! subdivision (SUB)
E create g lots or less
!tr $1so
$1so
$700ntr
ln conjunction with Single-Family Residence.. $325
All Others............. ............... $425
E Rezoning (RE4
El Planned unit Development (PUD) .
E Minor Amendment to existing PUD
E Sign Plan Review.......-.......................-.................. $150
E Site Plan Review (SPR)
E wetland eteration Permit (wAP)
ntr
Adminisrative...... ............... $100
Commerciaulndustrial Districts"...................... &500
Plus $10 per 1,000 square teet of building area( thousand square feet)
*lnclude n um ber of g!E!!g em ployees:
'lnclude number of 4gg emPloyees:
fItr
Single-Family Residence
All Others
E zonino Appeal
$200
$150
$275
$100
E zoning Ordinance Amendment (zOA)$500
E Residential Distric6 $s00 !!Z!E: When multiple applications are prgcessed co.lcu.rendy,
$e app,opriate tee shail b€ charged tsr each application.
Plus $5 per dwelling unit ( units)
E Notification Sign (city m install and remo,/e)s200
I Rroperty Owners' Lbt within EIOO' (city to seneraE after tre-aporicatio meai"s) ......"..fi5- ;d;;;;, ..........'$a per address
E Escrou/ for Recording Documents (check all that apply)
conditional Use Permit Interim Use Perm it ! Site Plan Agreement
Vacation n variance nn Wetland Alteration Permat
tr Metes & Bounds Subdivision (3 docs.) [ Easements ( easements)
TOTAL FEE:
Section 2: Required lnformation
Description of Proposal:
1601 Lake Lucy Road, Excelsior, MN 55331
Parcel #:254070200 Legal Description:
9.03 wetlands Present?n ves E r.to
See attached survey
Total Acreage:
Present Zoning Rural Residential District (RR)
Present Land Use Oesignation:Residential Lo\rv
Planned Unit Development (PUD) E
se Designation . Residential Low Densityfil
Requested zoning:
Requested Land u
Existing Use of Properry:Ruture Home Site
Elcheck box if separate nanative is attached.
suoniua oae IQP.!2!- "" D*E{-LL}2-
""
o*,
$50 per document
Deeds
$1,099.00
Property Address or Location:
Section 3: Property Owner and Applicant lnformation
APPUCANT OTHER THAN PROPERTY OWNER: ln signing this application, l, as applicant, represent to have obtained
authorization lrom he propefty owner to file fiis application. I agree to be bound by cond,tions 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 atiached separate documentation of full legal capacity to file the application. This application
should be processed in my name and I am the party whom he City should contact regarding any matter penaining 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 consuhing fees, feasibility studies, etc. with an estimate prior to
any authorization to proceed with the study. I cenify thal the anformation and exhibiB submitted are true and conect.
Name
Address
Contact:
Phone:
city/statezip:
Email:
Cell:
Fax:
Signature:Date:
PROPERTY OWNER: ln signing this application, I, as property owner, have full legal capacity to, and hereby do,
authorize the filing of this application. I understand fiat conditions of approval are binding and agree to be bound by those
conditions, subiect only to the right to ob,ect at the hearings or durino the appeal periods. I will keep myself informed of
lhe deadlines for submission of material and the progress ol 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 cenify that the information and exhibits subm itted are true and conect.
John VMcka
Address:
Name:Contact:
Phone:
City/Statetz ip:
Email:
Chanhassen, MN 55317 Cell:
Fax:
Oate
Cell:
Fax:
Contact
Phone:
john.wicka@gmail.com
Signature:LOl30l20
This application must be completed in tull and must be accompanied by all information and plans required by
applicable City Ordinance provisions. Before filing this application, refer to the appropriale Application Checklist
and confr with the Planning Department to determine the specific ordinance and applicable procedural
requiremeflts and fees.
Section 4: Notification lnformation
who should receive copies of staff repons?
trtrtr
D
Propeny Owner Via:Applicant Via
I uano Paper copy
E laaieo Paper copy
E Mailed Paper copy
E Mailed Paper copy
trtr
Email
Email
INSTRUCTIONS TO APPLICANT: Complete all necessary form fiebs, then select SAVE FORM to save a copy to your
device. PRINT FORM and deliver to city along with required documents and payment. SUBMIT FORM to send a digital
SAVE FORM PRItiIT FORM SUBMIT FORM
engineer Via E Emailoher via E Email
f,,o-o.
Address:
ciry/state/zip:
F-"i1.
2547 Bridle Creek Trl.
(612) 80s-62s0
PROJECT ENGINEER (it applicable)
A determination of completeness of the application shall be made within 15 business da)6 of application submittal. A
written notice of application deficiencies shall be mailed to the applicant within 15 business days of application.
'Other Contact lnformation :
Nr-o'-
Address: _
CMStateZip: _a-"il
copy to the city br processino.