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City of Gem Lake. Office: Use O <br />Date a1e Issu <br />Heritage Hall ed: <br />4200 Otter Lake Road.I Gem Lake, MN 55d.10 Base ree. S375.00 <br />bS 1-747-2790/92: I b51-747-2795 (fax} (1'pyafile:y> City ot`cem iukc) <br />ALL— y E-maiI cityaentlakenat_ .org Receipt. No. F:'1'-QED �16-1 <br />Interim Use Permit <br />'41I 111teriin Use Permit nray & granted or d6ded by tire City Council after reronurlendatlon by lire Planning <br />C01111.,issfun 111. accordance w1th OrJinance No. 131(zonlng), Section l%S Conditional and Iraterinr Use Perntlts <br />LICENSE APPLICATION CHECKLIST: <br />To.prevent delay, pleave ensure the following information is submitted <br />nterim Use Permit Application <br />Permit Fee (ifpaying with cash we can only accept exact change) <br />D $275.00 <br />,I!f' Site Plan <br />❑ Building Locations. (dwellings, garage, accessory buildings) , <br />© Site .Improvements (parking areas, drives,.sidewalks,.fences, decks, lighting. Cie.) <br />❑ Yard (front, side, rear setbacks) <br />11 Wetlands (delineation of streains, vvater bodies, wetlands & 1.00 year storm'elevation) <br />❑ Existing Trees (G inch in diameter or more), large shrubs & proposed lundscuping <br />❑ Location ofsite, with adjacent land use <br />D., Topography; Grading <br />D Schedule (m.hen application intends to construct) <br />:0 Additional information, if required <br />0 Permits or written comments from other agencies: <br />(DNR, RCWD, VLAWMO, Ramsey County,.MnDOT, US. Army Corgis 6f Engineers) <br />O Certificate ofSurvey or full legal description' <br />El Building.plans (size, intended use of -structures; exterior finishes, floor plans aitd elevations) <br />Phone: 6C)1 ' ��" % � -, Cc11: <br />Address: <br />rtv is zoned as: �C,. Existing Use of the site. <br />iption. of Interim Use. being requested: I �a ( [ -K4 <br />ppkant Signature: <br />Business., <br />State: 'j jy Zip: <br />Date: <br />City af`06t t.ulce Interim Use Permit - page. t.of 2 <br />