5.1. PCSR 01-08-2008 - Laserfiche WebLink

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Planning Land Use Application Page 2 Owner In//formation Name: ~~ ~ V1, ~ ~~, ~-I `3u1 ~ E-mail address: , Address: ~ L~ Q ~L~~ ~~-~' ~C7~ ~~C~ • 5tteet City State Zip Code ~. C' A ~ r Phone (w): ~ , Fax: ~ Phone ~7f-~/~'\ I prefer that mp copy of staff reports be seat by: Clas Mail ax ~ E-mail~(Check•oae) ' Signature: Date: • /'-~'~ ~ Billing Information (if different from either applicant or owner information) Name: Address: street Phone (w): State Zip Cnde V-• Fax: Pone (F~: Signature: ~ '~ Date: ~_ ~.%- ~' S 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 map 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 requited 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 fox costs will be requited 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 costs incurred in reviewing the application will be required as set forth in the policy, agrees to reimburse the City as requited in the policy and make payment when billed by the City, and agrees that the application map be denied for failure to reimburse the City for costs as provided in the poli ! ' ;- ! ~ Signature: ~~'~.~~ Date: ~ ^ ~~ ~~ <~ r r .r 4 _ ! y ~~, ~ Y ~4~Y 1 ~ ~~ ,t'.~ ,fy1rt.~~TC '~tiw M~ .f ~• . S:\PLANNII~3G\Fotms\Application Foans\Application Foan Rcvised 0124 05.doc