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I City of Gem Lake Received <br />Hei=itage Hall <br />f 420.0 Utter Lake Road E Gem Lake, NW 55:110 Aug23 2022 <br />{{i 651-747-2790192 [ 651-.747-2795 (fax) City .of Gem.Lake <br />Conditional Use Permit <br />A Condidoisal Use Permit may be granted a denied by: the City Council a, fter re cam in en dation by the Planning <br />Commissfort in accordance with OrdinanceNa- 137 (zoning), Section:17.5 Conditivnal.rrrad Interim Use Permits. <br />LICENSE APPLICATION CHECKLIST: <br />To prevent delay, please ensure the: following information is submitted where applicable. <br />D Permit Fee fifpaying with rash we can only accept exact change) <br />Q $275.00. (lpayable to the City.of Gem i:akc) <br />❑ site Plan <br />CI Buildiag Locations (dwellings, garage, accessory bul Win gs) <br />❑ $tte fmprovernents (parking areas, drivcs,:sidewalks .fences; decks, lighting, etc.) <br />C7 Yard (front; side; rear setbacks) <br />Cl Wetlands (delineation of st=irig.. water bodies. wetlands & 100 year storm clevation) <br />❑ Existing Trees (E inch in diaraact or more), large shrubs & proposed Iandseaping <br />El Location ofske, with adjacent land use <br />Ci Topography, Grading <br />D ScheduIe (when applicant intends. to construct) <br />0 Add!gonal information; ifrequired <br />0 P.erstlits or written c6mments from otbcr asencicss , <br />(DNFI RCWD, VLAWMO, Rarnscy County, WDOT,.US Army Corps ofEngincm) <br />© Certificate of Survey or full legal. description <br />0 Building plans (size, intended vie of structures, exterior finishes;. floor plans and elevations) <br />Ap1211 Cant Info rmati o n <br />Name: `T'A <br />flan-te phone: Cell: Business: <br />Emmf t: <br />Property Dwaer: f <br />Site Address: �y l f <br />City, Ge State: l L 1 Zip: <br />Property is zonod as: Existing p" of the. site: <br />Description of Conditional Use being rcquesied: <br />Applicant Signature: Date: (Al 06&::1 <br />!a�j • p� <br />Do is P " cdcog Advisory CTO nne s n Wa nin <br />I.understand that wrnc of thc'information provided on this form will be public data Public data is availabto to anyone who makes a request for such information, Linder <br />the Minnesota. Data Practices Act, your address, entail amdlor Wephene number are private data. You may choose not to prdvide same or all of thiis:priyitre d�ta;;but it <br />may eausti your Candit adal use Permit request to be denied. By 6onipleting this information, you are cunsenpng to allow: the CRY of.Crem lake staff to share this <br />information in, order to admim La nister Gem Ordinances tegardiag Conditional Use Pcrmi Ong. Plcase sign:6caffirm <br />3ow to arm that you have read this notice. <br />Applicant. Signature; <br />Date- <br />