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City of Gem. Lake <br />Heritage Hall <br />4200 Otter Lake Road i Gem.Lake, i1�N 5511.0 <br />651-747-2790192165.1-74.7-2795 (fax) <br />r <br />t. E-mail e:.ac�nR� T��irl�nr� <br />Agricultural. Animal Keeping License <br />Interim Use Permit <br />January 1— December 31 <br />LICENSE APPLICATION CHECKLIST: <br />To prevent delay, please ensure the following information is.submitted. <br />Agricultural Animal Keeping License <br />Application Fee <br />l � <br />ward 2nd year 5100.00 for up to 2 agricultural anintals; 5rd year and on renewal feels $50.00. <br />3 st and Nd year S160.00 for up to 5 agricultural animais;.3rd year and on renewal fee is $75,00 <br />Letter of Approval frmm Property 0caner (if applicant is not the owner of the. property on which agricultural animal s.are being kept) <br />r Site Plan detailing the fallowing information: <br />1. <br />Location of praperty Lines <br />1 House, garage. (where applicable) <br />1 <br />1 <br />Sipe :and Specifications of an6al :shelter <br />ISetbackproposed from the -shelter to the property lines <br />i ❑ New �. l st.year. Rencwal 2nd.year Renewal and On <br />Ayolicant Tgfvrtnation <br />Name: Nikki & Ted Pax <br />Phone Number: 651-272-8584 <br />Address: 3944 Scheu.neman Road <br />city:. Gem Lake state: MN zip 551 9 <br />Email: Nichole.Paxl3 yaYlo=om <br />Property Owner Information {if.different than applicant} <br />Name: <br />Email <br />Animal Information . <br />Phone Number: <br />Number and .species of agricitltural.anir;ials. housed.or.kept.ori property: <br />Currently have 2 .goats .and would like to add 2 more goals, <br />Purpose ofkeeping.agricultural animals on property: Landscaping' and for pets. <br />Would "in an organlc flips powder. in the ham drea avidoraand the fenced area <br />Describe the steps you intend to take toprevent todors, rodents, flies; and other pests- <br />0 "IP "" :4--, and*Pr � —N'M-., Nth"?"Wa Mom. N'�..m a"ir 14..'nn*rx .�+ 'w W. xwbd.a+tn. �—MY <br />Applicant Signature: <br />Receipt -No. <br />Approvedby: <br />Permf t No-. <br />Date: <br />r'-- ni'T..rn in1... A...•::... I"."1 A..:m..f Y......7..n i s D...e I —r7 <br />