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It <br />,,-AI�EN HILLS <br />Escrow Account Set Up Form <br />Date: 09/04/2019 <br />Site Address: 1770 WEST COUNTY ROAD E2, ARDEN HILLS, MINNESOTA 55112 <br />Deposit made by: <br />Amount: $ <br />CAROLE NIELSEN <br />Address to send statements: 4570 VICTORIA STREET NORTH, SHOREVIEW, MINNESOTA 55112 <br />Contact Person: CAROLE NIELSEN <br />Telephone No.: 651-621-6017 Email Address: carols.nlelsen@moundsvlewschools,org <br />Purpose of Escrow Account: REQUIRED PER "2018 LAND USE APPLICATION," FOR THE VALENTINE HILLS <br />ELEMENTARY 2019 ADDITIONS AND RENOVATION, REVIEW. <br />Arden Hills Finance Department policy requires that escrow deposits be held for six months once <br />a permit has been closed in order to ensure all costs associated with the project have been <br />covered. Please note: Land Use Applications may be required to maintain a minimum balance as <br />established by the City, and will require replenishment when balances fall below the minimum <br />balance. I acknowledge that I have read this policy and fully understand that any remaining <br />escrow alance will be released after a six-month waiting period. <br />Applicant Signature Date <br />Office Use Only <br />Staff Name: <br />Type of Escrow: <br />❑ Landscaping <br />❑ Grading & Erosion (PW# <br />❑ Site Improvements (PW# <br />❑ Security Deposit — Do Not Charge <br />Additional Notes: <br />Department: <br />❑ Land Use Application (PC# ) <br />❑ Temporary Certificate of Occupancy <br />❑ Other: <br />City of Arden Hills ♦ 1245 West Highway 96 ♦ Arden Hills, MN ♦ 55112-5743 <br />Phone 651-792-7800 4 Fax 651.634.5137 4 vww.cityofardenhills.org <br />