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<br />. <br /> <br />. <br /> <br />. <br /> <br />Planning Land Use Application <br />Page 2 <br /> <br />Owner Information <br />Name: Sarre as Applicant Information <br />Address: <br /> <br />E-mail address: <br /> <br />Street <br /> <br />City <br /> <br />Zip Code <br /> <br />State <br /> <br />Phone (w): Fax: <br />I prefer that my copy of staff reports be sent by: <br /> <br />PhoneJ...H): <br />E-mail D (Check one) <br /> <br />Signature: <br /> <br /> <br />Date: / 1;;( -t:Jt <br /> <br />Billing Information (if different from either applicant or owner information) <br />Name: N/A <br />Address: <br /> <br />Street <br /> <br />City <br /> <br />Zip Code <br /> <br />State <br /> <br />Phone(w) Signa:'~"~ ~e:~eo /-IJ-tfl <br /> <br /> <br />Agreement to Pay Costs of Review: <br /> <br />It is the policy of the City of Elk River to require applicants for land use approvals and licenses to <br />reimburse the City for costs incurred by the City in reviewing and acting upon applications, so that <br />these costs are not borne by the taxpayers of the City. These costs include all of the City's out-of- <br />pocket costs for expenses, including the City's costs for review of the application by the City's <br />environmental Consultant, City Engineer, City Attorney, or other consultants, and may also include <br />a charge for extra staff time to process particularly complex applications. <br /> <br />The City will bill the applicant for these costs as they are incurred, and payment will be due within <br />thirty (30) days of mailing of the bill. If payment is not received as required by this by this <br />agreement, the City will suspend the application review process and may deny the application for <br />failure to comply with the requirements for processing the application. Payment for costs will be <br />required whether the application is granted or denied. <br /> <br />The undersigned has received the City's policy regarding the payment of costs of review, <br />understands that reimbursement to the City of costs incurred in reviewing the application will be <br />required as set forth in the policy, agrees to reimburse the City as required in the policy and make <br />payment when billed by the City, and agrees that the application ma be denied for failure to <br />reimburse the City for costs as provided in the B <br /> <br />Signature: <br /> <br /> <br />Date: <br /> <br />/-/,/-t% <br /> <br />C:\Documents and Settings\tallard.ELKRNERPD\Local Settings\ Temporary Internet Files\OLKC7\Application Form Revised 09 06 OS.doc <br />