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City of Gem Lake Interim Use Application – Gem Lake Gardens - Page 1 of 1 City of Gem Lake Heritage Hall 4200 Otter Lake Road | Gem Lake, MN 55110 651-747-2790/92 | 651-747-2795 (fax) E-mail city@gemlakemn.org Zoning Request Interim Use Permit – Gem Lake Gardens Expires March 15th of Each Year New Renewal Property Information Property Owner: Address: City: State: Zip: Home Phone: Cell Phone: Applicant Information Applicant: Address: City: State: Zip: Home Phone: Cell Phone: List of Fertilizers, Pesticides and Other Agricultural Chemicals Being Used Data Practices Advisory (Tennessen Warning) I understand that some of the information provided on this form will be public data. Public data is available to anyone who makes a request for such information. Under the Minnesota Data Practices Act, your address, email and/or telephone number are private data. You may choose not to provide some or all of this private data, but it may cause your Conditional Use Permit request to be denied. By completing this information, you are consenting to allow the City of Gem Lake staff to share this information in order to administer Gem Lake Ordinances regarding Conditional Use Permitting. Please sign below to affirm that you have read this notice. Applicant Signature: Date: Office Use Only Permit No. City Council: 3rd Tuesday of the month at 7:00 p.m. at Heritage Hall, 4200 Otter Lake Road. City Council Meeting Date: Conditional Use Permit paid: Cash Check Check No.: Receipt No.: Date Permit Granted: Date Permit Denied: Conditions / Requirements