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City of Gem. -Lake Office Use°Only. <br />Heritage Hall Date issued: <br />4200 Otter Lake (toad I Gem Lame, MN 55110 Banc Fee: $275.00 <br />bS 1=7'E7-279U/921-65.1-7a7-2795 (fax) ;r,y„tar to City o;`cem take) <br />E-mail city�%netttlai:etren.org Receipt iv`o.. pll � rj � <br />i <br />Interim Use Permit <br />Ait Ittterint.Use-Perna t may be granted or decried kit the QY Council after recontntemladon b)� the.Planning <br />i Commission lit d.ccarduriee with Ordbianee No. 131 (zoning), Section AS Conditionat-and Interint Use.Perndls. <br />LICENSE APPLICATION CHECKLIST:. <br />To prevent delay; please ensut-e the following information is submitted <br />Interim:Use Permit Application <br />Permit Fee (if paying with cash we can only accept exact change) <br />© $275.60. <br />, J �M cW pie <br />,,i_'i <br />site Plan <br />- O <br />Building Locations (dwellings, garage. accessory buildings) <br />Len Va <br />13: <br />Site Improvements (parking areas; drives, sidewalks, fences; decks, lightin& etc.) <br />.© <br />Yard (front, side, rear. setbacks). <br />O <br />Wetlands (delineatiop of streams, water bodiesi wetlands.& 1.00 year storm elevation) <br />G <br />Existing Trees (6 ik in diameter or more), large:shrubs & proposed landsc�iping <br />O <br />Location of site,. with adjacent land. use <br />f f V-b+e - <br />O <br />Topography, Grading. <br />0 <br />Schedule (when application intends to construct) <br />11. <br />Additional information, if required <br />Permits or written comments front other agencies: <br />(DNR, RCWD, VLAW:MO, Ramsey County, MuDOT, US Army Corps of Engineers) <br />❑ <br />Certifiente ofSurvep.or-full legal description <br />Q <br />Building -plans (size, intended use of structures, exterior finishes.: floor plans and elevations) <br />onw Phone <br />Address: <br />IF <br />coil..Business: <br />iu <br />— -�y - -C .v�r •_ �+°-1L-C.. Siate:. tit Zip: <br />rty is zoned as: Existing use of the site: <br />of Iitteritn Use being requested: " 1't� ( rt`c ! �� o.� C?�� t <br />,.>- t lb. <br />Signature: <br />Date; <br />City 01'Gem Lake Interijn Use Pcnnil - Page t <br />