4. CENTRO PROP GPCase Number: ~' L . ~~ ~ _ ~ /
General Planning Application
Temporary Sales/Storage of Fireworks
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Property Information ~~ ~
Address: ems, ~\ 2 ~~-r ~ €7r~t ~- ~w Parcel Number: 75 - ~ - Oil C~
Legal Description: (attach if necessary)
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Applicant Information
Name: ~t'lcaer\L ~_.~~_ ~,`r_i-.~ r~ . E-mail address: mr:~-~ c-~x~x:~~c.~x~t ~~~ r~~c>~ \~~ ~ c_~
Address: t 1~~"1 ~~~~~~ ~-e c ~~ ~~-,! ~ rnr-~ G~.t ~
Sweet .City State Zip Code
Address of Fireworks Sales: t ~ t i2 ~r-e ~c~ ~- ~-,t: -c-~-~
Owner Information
Name: 2.~-~~-Y-Z~ ~c-~ E-mail Address:_ ~~~ t'~-
Address: ~2b \~~~ r, c; -,~ ~. ~ , ~ ~ rst \C \•:~~ ~.C:~l®t f~
Sweet City State Zip Code
Phone (w): 'Zt2` ~-~ Fax: Z~2~ ~~~5`t~ Phone (h):
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Signa*_ure: Date: _~,
~e~cription of Pr€~~ect , l~~k'YI~C ~~
Please describe your project/reason for your request If necessary, attach a written narrative. ~ ~~ ,
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Site Plan
A site pla=y of the proposed location and layout of the tern:~ora_~ s=~ <t,are any? its sz~}-~~=?r -_ Js ~-~-,--
bi submitted. - --- -
~, Site Plan completed and attached to applicat_+on.
Agreement to Pa~C ~ogt~ of I'~evicw:
It is the ~o??cy= of the City of Elk. River to require applicants for land use approvals and
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Dates of Fireworks Sales: ~~r~~ ~ ~~ ~` ~? [`~ ~\ - ,.,. ~ 3 ~~' 2r~ i 1
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.
's'he qty will bill the applicant for these costs as they are incurred, and payment will be due within
t~~rt<J i:~0) days of mpg of the bill. If payment is not received as required by this agreement, the
city ~:ry-i;I suspend the application review process and may deny the application for failure to comply
s~~r~~, the rectuiser_raents for processi_r?~ the a~p??cation. I'a~~ment for costs ~,~,~Ii be recit,;~-ed whPr_hP_r
the application is granted or d..ued. -
''`~ zind~=rsir«~d has recci:-ed the city's ~oLcF; regarding the pa~?nent of costs of review, understands
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- - -- "' - S t~ ~~=ii.~urSi...E_~ ~`iiY aS r.if'!2=rt.E`1.. Izi €`.=1C ~7oucy aia~ i2'ia.iii. payiiiiiit wit.ii
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Signature of Fire Chief/Designee:
Date:
Council Approval Granted:
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