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Address /Street Location of Property Xerxes Ave. North and Co R 10, Brooklyn Center, MN
Legal Description of Property "See Attached"
A preliminary meeting with the Planning Staff is required prior to the submission of a Planning
Commission application. No application will be accepted prior to such meeting.
Applicant Information: Owner Information:
Name Loren Van Der Slik Name Loren Van Der Slik
Address 101 South Main St., Dickson, TN Address 101 South Main St., Dickson, TN
Phone (615) 446 -7109 Fa (615)446- -7105 phone (615)446 -7109 Fax (615)446 -7105
Email Email
Type of Request: Rezoning ($1050) F Special Use Permit ($200)
Subdivision Approval ($300) F-1 Site & Building Plan Approval ($750)
Planned Unit Development ($1800) FI Appeal ($200)
Variance ($200) F-1 Other:
Description of Request: Planned Unit Development, Submitting Preliminary Plat,
and Site and Building'Plan Approval for the Shingle Creek Crossing
development.
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Application Fee $ . C' Acct No, 1010GA403 Receipt No. � g
The applicant requests processing of this application and agrees to pay to the City of Brooklyn Center, within
fifteen (15) days after mailing or delivery of the billing statement, the actual costs incurred by the City for
Engineering, Planning and Legal expenses reasonably and necessarily required by the City for the processing of
the application. Such costs will be in addition to the application fee described herein. Withdrawal of the
application will not relieve the applicant of of the obligation to pay costs ineurre prior to withdrawal.
1 - � r
Loren Van Der Slick C_ I & W
Applicant (Please Print) Applicant's Signature
Page 1
City of Brooklyn Center - Business and Development - 6301 Shingle Creek Pkwy - Brooklyn Center MN 55430 763 -569 -3300
Planning Commission Application Fonn 10 -10
i
City Use Only City . Use Only 06 Use Only
Planning Commission Recommendation
Dates of PC Legal Notice Notices Mailed Action Taken Approved
Consid Published Resolution No.
VD 0 f 0 - o
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Approved Denied this 2 b day of t 20
subject to the following conditions:
Chairman
City Council Action
Dates of Council Legal Notice Notices Mailed Action Taken Approved Performance
Consideration Published Resolution No. Bond
Received
L_] Approved ❑ Denied this � day of 1 ►�i _ 20 �+
with the following amendment:
Clerk/Planning Commission Secretary
Page 2
City of Brooklyn Center - Business and Development - 6301 Shingle Creek Pkwy - Brooklyn Center MN 55430 763 - 569 -3300
Planning Commission Application fonn 10.10