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s <br /> r <br /> w <br /> 3 " <br /> ■ sr: <br /> far+ 4' ■ a ': <br /> Land Use Application <br /> it. 0 <br /> ? <br /> r> <br /> t <br /> I <br /> ❑ Plat,V,, 4* Ian ❑ Plat--Preliminary Plat ❑ Plat Final Plat <br /> r-1 Admi�nistrafive Plat .� El Site Plan Review ❑Administrative Site P an Review t <br /> ❑] Conditional Use Permit ❑ Interim Use Permit El Comprehensive Pl 'Amendment <br /> F-1 Zoning Ar6Qndment Home occupation Permit Variance ` <br /> n Dweliing Moving Permit ❑ Environmental Permit Registered Land Survey <br /> r <br /> ❑] Non--Traditional Animal License ❑ ROW Vacation EJ Private Fennel License k '= <br /> ❑ Easement'Encroachment ❑ Easement Vacation El other <br /> Applicant Contact Information <br /> ' Please note;all official communication will be routed through this contact. 3 <br /> 1 <br /> 11 ■1 <br /> k F/. <br /> x <br /> r <br /> Name. 3. , <br /> f e <br /> street Add re , <br /> ■ f I i'• ■ <br /> it f State -Zip:' GS303 <br /> r <br /> s <br /> Home Phone;'+ lh]arlt Phone; 6 1z3o f)5-56 ' <br /> t <br /> E ii a i l: YYLI Fax Number: <br /> Name of Busi ess(ifs I <br /> it f <br /> a licable , 1� <br /> pp � r <br /> Business Address(if applicable) <br /> Business Cit j,State Zl P. ` <br /> Business Phone: -; 3 Business Fax; } <br /> Subject Property Information <br /> (Location of application) { <br /> Address �1• � ��, �� i� ��-��� U� �� ��� ��J� <br /> PIN ! <br /> r a <br /> r <br /> Legal'De rip Lion <br /> Zoning District: <br /> r <br /> Contact the* Plahning;ii iirsion tit 763-433-9524 or planning@citvoLr!imsey.com to request a Zoning Verification <br /> ;oH <br /> 1 r <br /> z 3- 1 <br /> I <br /> a <br />