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City of Gem Lake <br />Heritage Hall <br />4200 fitter Lake Road I Gerrt Lake, MN 5511:0 <br />651-747-z7 M2 1651447-2795 (fax) <br />E7mail .ITV%i+y�LiYi .Ii:wl]?Cl.�1C <br />Agricultural Animal Keeping License <br />Interim Use Permit <br />January.1— December 31 <br />LICENSE APPLICATION CHECKLIST: <br />To prevent: delay, please ensure thEjollowing inforn atiun'is. subinitted. <br />Agricultural Animal Keeping License: <br />Application Fee <br />1 st and 2nd:year $100.00 for:up to 2. agricultural animals; 3rd year and on renewal fee is S50.00. <br />Island 2nd year.$'166MO fnr up to 5 agdcuitural animals:3rd year and on .renewal fee is 575,00 <br />Letter of.ApproM from Property Owner (if applicant is not the own er.0f tbe.propertyon which.agricultural animals arebeing kept) <br />❑ :Site Plan detailing the following jnformation: <br />Location ❑f Properry Lines <br />I•lorase, garage.(wliere applicwr) <br />Size and Spmi ficatinns of animal shelter <br />Setback proposed from the shelter to The property.]ines <br />.New M ist year Renewal 2nd.year Renewal. and On <br />A,p0icant Information <br />Name:: Nikki & Ted Pax <br />Address: 3944 5cheuneman Road <br />Gil,. Gem Lake <br />Email: Nichcl.e.Paxl3@yahoo.cam <br />Prop edy Owner Information (if different than applicant} <br />Name: <br />Email: <br />Animal Tniormation <br />P.hone:Number. 651-272, -8584 <br />state: MN <br />Phone.Nurnber: <br />zip: 55110 <br />Number ecies of u andsF p icu.IturaI an p on roPnY� . housed or kept e Currently have 2 ghats and would like to add 2 more goats.. <br />Purpose of keeping agricultural animals on.property: <br />Landscaping and for pets. <br />Would use an organic fte powder in the barn area and around the fegced'area <br />Describe thesteps.yon intend. to take to prevent ❑.dors,.rgdents, flies; and other pests: <br />wpp a gang wp:nh+.h...Me�:nbsaw VrMM.wpnw.efw�'rw:ano mtano-.w.m+.�va.wrydo.nupiti�eraawgr.an.waaw nwnw�eiF w. »aie.cL.n me p.n w�uy <br />Applicant Signature: <br />Office Use only <br />Approwd by: <br />Date:. 912 2l23 <br />Rmeipt No. Permit No:, <br />Date: <br />r:..• rr, i:r.a A.Ya. T.. n..,l .A—: I v-- :- i.: D_e;r S'.;FT <br />