6.3. SR 02-16-2010 - Laserfiche WebLink

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2~Q9 Land Use Application Form Page 2 2Jzo/zoQ9 Last Modified p~~icant ~n®rmati~n Name; ~ ~~ fl ~ 1~ ~ ~ ~~ ~ ~ ~~ ~ ~ E-mail address, [~..~ ~ +~ ~~1~' ~~~~~ _ .~ f Address, ~ (~.~ r ~ ~..~~~~ ~ % ! U ~~ ~n,~ ~ ~ .~ Street Cite State Zip Code Phone ~w~; Fay;; Phone ~H}; I prefer that any capy of staffreparts be sent by; lsr Class .Nfazl ~ Fax ~ E-mail ~ (Chcck one) Signat~~re; Print Name; Date; pry art ~rr~~r ~n~®rP°Ylat[~n Same asApplr'cant Drffere.~t, as below (Checkor~e~ Name: E-mail address; Address; Street City State Zip Code Phone (w); Fax; Phone ~H~; I prefer tbatmy capy ofstaffreports be sent by; 1Sr Class Marl ~ Fax ~ E mad ~ (Check o.~e~ Signatiuxe; Print Name; Date; I~~It~ In~®@"~11a~t1®n Same asApplfcant Same as Prope,~tyQ~v~ex ~ .D.rfferer~t, as below ~ (Check aye) Name; E-mail address. Address, Street Phone (w~; Fax; Signature; Print Name; ~r~enn~nt t® ay ~sts o evie~; Citsr State Zip Cade Phone ~; Date; It is the policy a£ the City of Elk River to require applicants for land use approvals and licenses to reimburse the City for casts incurred by the City in reviewing and acting upon applications, sa that these casts are not borne by the taxpa~rers Of the City, These costs include all of the City's out-af-pocket casts far expenses, including the Cit~t's costs for review of the application by the City's environmental Consultant, City Engineer, City Attorney, ar other consultants, recording fees, necessa~.y publication costs excluding public hearing notices, and may also include a charge for extra staff time to process particularly complex applications, The City will invoice the applicant far these costs as they are incurred, and payment will be due within thirty ~3Q~ days, Zf payment is not received as required by this agreement, the City- will suspend the application review process and may deny the application for failure to comply with the requirements far processing the application, Payment far costs will be required urhether the application is granted or denied, The undersigned has received the Ciry'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 maybe denied for failure to reimburse the Cite for costs as provided in the policy. ~narire; Date; 1 .. ~~FAi.• ~ ': Print Name; ` ~ -~ ~ ~ Se~PLANNING MAIN~Admin~AppGcation P'orms~Land Use Application Form Z009,doc