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City of Gem Lake <br />Heritage Hall Received <br />4200 Otter Lake Road I Gem Lace, MN 55114 Aug 23 2022 <br />651447-2790/921651447-2795 (fax) City of Gene Lake <br />E -Mali l Clt"Lt i f 11,t_Kg <br />Conditional Use Permit <br />A Conditional Use Permit may he granted or denied by the City Cauneil after recommendation by the Planning <br />Commission in. accordance with Ordinance No. 131 (zoning), Section 17.5 Conditional and interim Use Permits. <br />LICENSE APPLICATION CHECKLIST:_.. _...._._.r_........_ _...,,_..._�... _... .w...._. . <br />To prevent delay, please ensure the following information 1s submitted whert applicable <br />❑ Permit.Fee (ifpaying with cash we can only accept. exact change) <br />❑ $275.00 (payable to the. City of 0cm. lake). <br />❑ Site Fiats <br />❑ Building.Locations (dwellings, garage, accessory buildings) <br />❑ site Improvements {parking areas; drives, sidewalks; fences, decks, lighting, etc.) <br />O Yard.(front, side, rear setbaclas) <br />❑ W elands (delineation of streams, water bodies. wetlands & IOD year storm elevation) <br />f l .Existing Trees (6 inch in diamoter or mone),.large shrubs & pr6poW landscaping. <br />❑ Location ofsite, with adjacent landuse <br />❑. Topography, Cog <br />❑ Schedule (when applicant intends to construct) <br />❑ Additional information, ifrequired <br />❑ Permits or written comment& from other agencies: . <br />(DNR; ROM, VLAVIMP, Ratnsey.Couttty, MnDOT,M Army Corps ofEngincers) <br />❑ Certificate of Survey or full legal descriptions. <br />❑ Building plans (slze, intended use of stiuctuics,exterior finishes, floor pWs and elevations) <br />Allnl€eantTn fo rroution <br />Home Phone: <br />Email: <br />call; <br />Business: <br />Propmny Owner; —al r u iA-L- . P&I _ <br />Site Address: <br />city --Gem I.:c� State: h N Zip: 5s11 D <br />Property is zoned as: Existing usenfthe site: <br />F being �S 04 ti7�rS Qjnj <br />Description of Conditional Use tieiii estcd: <br />Applicaut:Signature: Date: <br />Aatri Yrastlees Advlsory MnRasin Warntnel: <br />t understand that some of the information provided on this form will be public data:. Public data is available Wanyone who makes a requestfor such infomustion. Under <br />, theMinne.sota D7a .Practices Act, your. addrem, email andlor telephone mum*. am private data. You may choose not to provide so=oral: of -this private data, but <br />may cause your Conditional Use Penrut request to be denied. .By completing this inf6rmatiop, you are consenting to.allow.the City: of GcEni Ake staff to share this <br />Information in ardw to tdininister Gem Lake Ordinauoes regarding. Conditional Use Pcrmiting Please sign below to adirm that you have read -This notice, <br />Applicant Signature: <br />Date: <br />City of Gem lake Conditional Use Peituit -Page I of 2 <br />