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•Planning Land Use Application Page 2 Billing Information (if different from either applicant or owner information) • Name: Address: Street City Stare ZipCode Phone (w): Fax: Phone (I-I): Signature: Date: Agreement to Pay Costs of Review: It is the policy of the City of Elk River to require applicants for land use approvals and licenses to reimburse the City for costs incurred by the City in reviewing and acting upon applications, so that these costs are not borne by the taxpayers of the City. These costs include all of the City's out-of- pocket costs for expenses, including the City's costs for review of the application by the City's environmental Consultant, City Engineer,City Attorney, or other consultants, and may also include a charge for extra staff time to process particularly complex applications. The City will bill the applicant for these costs as they are incurred, and payment will be due within thirty(30) days of mailing of the bill. If payment is not received as required by this by this agreement,the City will suspend the application review process and may deny the application for failure to comply with the requirements for processing the application. Payment for costs will be required whether the application is granted or denied. • The undersigned has received the City's policy regarding the payment of costs of review, understands that reimbursement to the City of c s incurred in review' he application will be required as set forth in the policy, agrees to re'. b se the City as re. .• e. in the policy and make payment when billed by the City, and agrees at e application .y b: deme, for failure to reimburse the City for costs as provided in - olicy. Signature: (-22C.re2 �C Date: 7/25/(1'7 Description of Project/Request/Name of Plat Please describe your project/reason for your request. If necessary, attach a written narrative. 2 �4 y/ c r� a G l < -%-E'- (2�J) T/ ‘°'!7 mac-/ e—,�'1^c� ((! pre4 .6z•LJT YR(e /i 7 Cci.fc-�t-c (-)Lyj s 1�7 ' s A-4 L0171 . 1 E 1 (9) Submission Requirements • The City requires six (6) copies of all required drawings. Drawings shall be folded, at a scale no smaller than 1"=50', and no larger than 24"x36" in size. One (1) set of 11"x17" reductions is also required. All required information must be submitted on the application date in order for an • S:\PL.ANNING\Forms\Application Forms\Applcation Form Revised 4 21 03.doc