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City of Gem lake <br />I-lcritagc Hall <br />4200 Otter Lake Road I (icm Lake, MN 55110 <br />651-747-2790/921651-747-2795 (fix) <br />E-mail 6y6i;vemlakrmn_cirs, <br />Zoning Request <br />Interim Use Permit — Gem Lake Gardens <br />Expires March PVI of Each War <br />New Renewal <br />Proneriv Information ' <br />Properly Owner: <br />City. - � . . -z— <br />Ilome Phone- i— ' Cell Phone: <br />Applicant information <br />Applicant: <br />Address: <br />City: -------- <br />llonic Phonc: Cell Plwne. <br />LinI of Fertilizers. Pciticides-ion(I Other APricultural (Iicmicals Bvjn r,-Ll-%�-d <br />Received <br />MAY 0 1 2024 <br />City of Gem La <br />State -tL. zip:<���7'/� <br />State: "lip: <br />Data Practices Athisoa 1Tennessen Warningl <br />I understand that sonic of the inrornration providLd on this furnt will be public data. Public data is available to anyone who makes a icgnem fix such information. Under <br />j the Minnesota Data Practices Act. your address. email and/or telephone nurnber are private data. You may choose not to provide sonic or all of this private data. but it <br />may cause your Conditional Use Permit request to be denied. By completing this inlirrtnaiion, you are consenting to allow the City of Gem Lake stai'f to share this <br />inlornatimt in order to administer Cr Lake C imanccs rcgardingCnnditionat ll:c Permitting. Please sign Ixlow to atTrrn that you have read this notice. <br />-- .A Applicant Signature: ,_.__ / / Datc: <br />A <br />i <br />i Office Use Only Permit No_ <br />I <br />City Council: 3rd Tuesday afthe morah at 7:00 p.nr. at (lcritagc llall, J_'OU (Xtcr Like Road. <br />City Council tvlccting 1)41c:---_._..__._--- -—_----- .-- <br />Condhionul t)w Permit paid: ED Cosh U Check <br />I <br />Check No.: -- —_ Receipt No.: ---- — _ <br />Mae Permit Granted: Date Pennin Denied: <br />Conditions 1 Reyuireurtais <br />