Conditional Use Permits - Permit# 22-03 LUA - 4165 Shoreline Drive - 11/7/2022 Application No. 22- — LUA
CITY OF SPRING PARK
GENERAL LAND USE APPLICATION
SPRING PARK
On L*Minnetonka
APPLICATION TYPE:
❑ Ordinance Amendment ❑Variance Request ❑ Interim Use Permit Request
Conditional Use Permit ❑ Rezoning Request ❑ Site &Building Plan Review
❑Administrative Permit ❑ Other(please specify below)
PROP RTY INFORMAT N
Property Identification Number(PID):
Street Address: 4 V 10y 'IoL bcQ r i n 1 v S
Legal Description: `��,f
Other Information: 1 CCi�S t C Clot �d Su Yves/ N O . 1 [0 6 t�����p
APPLICANT INFORMATION
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Appli an ame id 4Phone T-M [ dineisuu-&
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Business Name Cij State Zip Code
Business Address mail Address
t F0 lti - 720 - 146-1
Name Title Contact P rson Cell Phone# For Contact Person
PROPERTY OWNER INFORMATION (if different than applicant)
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Owner's Name Phone
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usiness Name- Sbo rel.Ine, r � ity � � � Stat� Zip Code
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Business ddress R E-mail Address
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Name itle Contact P son Cell Phone# For Contact Person
DESCRIPTION OF REQUEST
Existing Use of Property:' U l d1 ��r
City of Spring Park-4349 Warren Avenue,Spring Park,MN 55384
Phone: (952) 471-9051 / Fax: (952) 471-9160 /Web:www.ci.spring-park.mn.us
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Nature of Proposed Use: I _ct
Reason to Approve Request: r eL N ill
Please describe any previous applications pertaining to the subject site:
Project Name: I 1 I& `f 2 Ck t to LIA,�9_
Date of Application:b I
APPLICATION FEES& EXPENSES:
The undersigned has paid the application fees and posted the required escrows for this application. The undersigned agrees to
pay all expenses incurred by the City of Spring Park for review and processing of this application,including expenses for legal,
planning, engineering, administrative and/or other professional services. If these expenses exceed the application fee paid and
the posted escrows,the undersigned understands and agrees that it is the responsibility of the applicant and property owner to
pay such expenses in full within 30 days of the date of the bill from the City. If the City does not receive payment in full within
30 days of the date of the bill,the City may approve a special assessment against the property for the full amount of such unpaid
expenses and the property owner specifically agrees to waive all appeals under Minnesota Statutes 429.82. All fees and expenses
are payable in full whether the application is approved or denied. Escrow funds received in excess of the City's expenses for
review and processing of the application will be returned to the applicant/property owner.
I,the undersigned,hereby apply for the considerations described above and declare that the information and materials submitted
in support of this application are in compliance with adopted City policy, code, and ordinance requirements and are complete
to the best of my knowledge.
I understand that this application will be processed in accordance with the established City review procedures and Minnesota
Statutes Section 15.99,as amended,supplemented,or replaced from time to time,at such time as it is determined to be complete.
Pursuant to Minnesota Statutes Section 15.99,as amended, supplemented or replaced from time to time, the City will notify the
applicant within 15 business days from the filing date of any incomplete or other information necessary to complete the
application. Failure on my part to supply all necessary information as requested by the City may be cause for denial of this
application.
A complete application shall include a completed and signed application form,payment of all required fees and escrows,and a
complete plan submission for the specific application.
The undersigned, an applicant for a permit under the rules and regulations of the City of Spring Park, understands and
consents to the release and use of private or confidential data,as described above.
I acknowledge and grant permission to any City staff members, city consultants, council, or planning commission members
to access the property named in this application at any time during the application process in order to view, evaluate and
understand this request.
Applicant Printed Name: JLCA 7 O `S`-'" ' Date:
Property Owner: h o l co ff:,'(� Lam/
(For office use only)
Date application received: I �� Property owner permission? Yes No
Fee Amount:01 DO b• "V Receipt/Check#: Q� Sample written notice to prop.owners? Yes No
Escrow Amount:—` 15 •V��lluReceipt/Check#: OZ'G7 3L%% Certificate of Insurance? Yes No
Orono Police Dept Approval? Yes No Severe Weather/Emergency Plan? Yes No
By: Date: Alcohol Security Plan? Yes No
Mound Fire Dept Approval? Yes No Master Site Plan? Yes No
By: Date: Additional permits? Yes No
City Staff Recommendation? Yes No Food truck? Yes No
By: Date: Temporary sign? Yes No
City Council Approval? Yes No Building permit? Yes No
Additt/i��onnal conditions attached? Yes No :NIFD—tent,fireworks,rec. fire? Yes No
Permit#: G�lCY�(J � � Date: HC/LMCD/Three Rivers? Yes No
Comments:
75-1752/910 2182
OLSEN GLOBAL LLC -
3066ISLAND VIEW DR.
MOUND,MN 55364 DAB .�
PAY TO L 1'30o;--
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LOOK FOR FRAU"ETERRING FEATURES INCLUDING THE SECURITY SQUARE AND HEAT.REACTIVE INK.DETAILS ON BACK.