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1 Owner Parcel # Mailing Address Permit # City Date Submitted State, Zip 60 Days Day Phone Fee Cell Phone Date of Hearing: Email Property Address Subdivision Twp Section______ Applicant Applicant Same as Owner Name Address 1 Address 2 City State, Zip Email Day Phone Clay County Planning & Zoning 3510 12th Avenue South, PO Box 280 Moorhead, MN 56561-0280 Tel (218) 299-5005 Application Fee: $225.00 Conditional Use Permit Application 03/2021 ---PAGE BREAK--- 2 1. Describe the nature of this request: 2. List any potential conflicts with existing nearby land uses and how any conflicts will be minimized: 3. Check all additional supporting documents and data, which are being submitted to help explain this project: ❑ Sketch Plan ❑ Topographical Map ❑ Detailed Narrative ❑ Engineering Plan ❑ Flood Plain Hydraulic Analysis ❑ Flood Proofing Plans & Specs ❑ Other (specify) To the best of my knowledge, I certify that the information provided on this application and accompanying documents is true and accurate. Applicant signature: