6.1. SR 01-22-2008 - Laserfiche WebLink

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Planning Land Use Application Page 2 ®wner Information Name: ~ IVY, ~~~~I`~.t'1~ E-mail address: Address: ~ L~. Q tu~I~ ~1~,~-~ ~~?~ ~ , cStreet~~ nn ~ City State Zip Code Phone (w): ) !;+`Fi:~'~ ~ Fax: ~-~ Phone ~~ I prefer that my copy of staff reports be sent by: t CIas Mail ax ~ E-mail (Check one) Signature: " ~-'l_/ Date: ~ ~' ~ `' ~ Bi[Iing Information (if different from either applicant or owner information) Name: Address: Street State .Zip Code V` Phone (w): Fax: Pone ~: Signature: Date: ~~~ Agreement to Pay Costs of Review: It is the policy of the City of Elk River to require applicants fox land use approvals and licenses to reimburse the City fox 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 fox expenses, including the City's costs for review of the application by the City's environmental Coxlsultant, 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 fox processing the application. Payment for costs will be required whether the application is granted ox 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 required in the policy and make payment when billed by the City, and agrees that the application may be denied for failure to reimburse the City fox costs as provided in the poli ! f~. ~ Signature: ~'C..1~ Date: ~~~~~ ~ ~~ r « s6t N . t ~~ ~ ass, .,.. ,. -?•' ._ q. .*~ . _. S:\PLANNING\Fonns\Application Fomu\Application Foan Revised Ol 24 05.doc