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<br />LG220 . Appllc;alioA-for E.9.,l'QIlt Penn it r:::
<br />Ol9l1nlnlion NI""'_ .~~ oRl ':) fijt:lLC T 'l)tlN OPrTI OrJ
<br />LoeIIl Unit 0' Govamment Acknowledgment
<br />If lhl ,"mllllng P'"
<br />city mullt .'gn 1hI.
<br />On behaW 0' !Me c~
<br />
<br />Ch..,
<br />thl city i. to
<br />The cIIy appmv
<br />w1IitingperiodG
<br />
<br />O The elly appro,"
<br />WlIlllnll penod.' '
<br />permtt a1'\e, 30
<br />eity).
<br />
<br />o The city den i...
<br />
<br />,.mIAfCIly.~
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<br />(Sign" '" Qr cil)o ~e"',
<br />
<br />TIIll Cni ._J1i
<br />D*~.A2 "7,.' ()
<br />
<br />Chief Executive
<br />The inlormatlon prr'
<br />
<br />Chr.f ,*uCNe ollb
<br />
<br />Name (plllase pmt)., ,
<br />
<br />Mall Appllcatlol
<br />
<br />AI lAst 45 dB)'5 p~"
<br />. the complel'Jd
<br />II eopy 01 yc
<br />. . $25 IPP'. ,
<br />Application ,
<br />
<br />Send to: Ga n
<br />17 -
<br />RO,I
<br />
<br />,,- ( )
<br />A;:~~~ A.
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<br />3Jl)1
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<br />---,
<br />"".. Is wlIII'n city nmllll, thl If tho ~=bAnll pNfllIaK is lOGMiId In I lIMn.hlp, bDIIl
<br />;. ppllcallon. 111. cou and tow!I8hlp must ....n 11110 Ipplt"1I0n.
<br />, ":~nowIedge1tli. applicBlion. On behalf 01 the eounty. I oi::knowledlle thl. appHcation,
<br />k the alltion tho ClNc:k lIIa actIOn that
<br /><I"1i on thla IppllcIUon. the county III tlklng on Ill" Ippllc;ltlon.
<br />,~ th e appllce1lon wfth no , :'\ o TIle county .pprows the appllcallon wi1h no
<br />({f:$Q.l<(;>>J NO., 02. -If I,) welting period.
<br />.s Ire applle8lloll with . 30 dey o The countj IIpptOYtl tile appic;llkln wfth e 30 dBY
<br />nd ,~I~ the Board to Issue a
<br />,,1\". /60 d.ya for .hl cla1i~ w.ltInl period, II1d ellowt the BoiW to issue a
<br /> perm after 30 days.
<br />'J'" .pplica~oo. o The eountj dlll_IIIe .ppllca1lon.
<br />11'1 OF /j.iJC;N H'LL~ PrIIIl nllM Of _nlY
<br />__a .J...h (sign8ture or coulllY pemonel naMrlg .ppbllon)
<br />"."i .I!(;elllng opplicali:>n)
<br />tG4ft./Ilt:=R 111Io
<br /> o.to--1_J_
<br />.4.., TOWNllHIP: On bell'" of tIl. _"''''. f ecl"\I,,,,lIdg.lIl11
<br /> Ill. OlIIIIII~n illPPiJ/ng Ib, ~'*" glltll*lg aClIYly
<br /> .In lhIlt/WnShip 1mb. IA loWIIeIl/p hu no IIldulorY
<br />...-. lIulhOlly to ~prow or deny lU't tppbton (MM. Sllll -,
<br /> 3ofU13, ",bol. 2'.J
<br /> Pr1nI ,,*IM of IDwnIHp _
<br /> (S'9Ml1J"Of~olllclel~ ....-1Iu.)
<br /> TIlII
<br /> o"~-1_
<br />...--.,.
<br />Offh::er'a Signature
<br />'d~.,j In this appPC8tlOll1s complete and accur.lle 10 the beat of my knowllldll',
<br />~~ '"<lnalure
<br /> l)8IIJ '---1_
<br />'u
<br />an d AttlIchmente
<br />,tt\ your $Cheduled actMty dllle send, If)'QUr IIllPllee1ion h.. nol
<br />l"Pplicllllon.
<br />,t pcoor of nonprtltll status. and been ~ by1tre
<br />'Mil '" (m8ke cheo;k payabl'lO "Slate Of Mlnnuola"). IoalI un' of !lO"lf'"mant 0(
<br />~!" .;nl not prora1ed, refundable, or tnInalel'8ble. haS been d,"lo:d. do nol
<br />bllng Control Board ..,d ilia appbllon 10 1he
<br />, Wnl (;()unly R".d II, :Illite ~OQ $outh o.mblna Conlrol Bo~.
<br />....'11.. MN 65113
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