Application- signedDocusign Envelope ID: C5239BEC-ED00-83B4-8328-ACF5F2EA942F
0 CITY OF CHANHASSEN
Development Review Application
COMMUNITY DEVELOPMENT DEPARTMENT I Planning Division
7700 Market Boulevard, Chanhassen, MN 55317 (P.O. Box 147)
Phone: (952) 227-1100 / Fax: (952) 227-1110
SECTION ONE: APPLICATION TYPE
Check all to apply. Refer to the appropriate Application Checklist for required submittal information
that must accompany this application
D Comprehensive Plan Amendment ...................... $700 D Subdivision (SUB)
D conditional Use Permit (CUP) D Plat 3 lots or less .......................... $500
D Single-Family Residence ............................ $400 D Plat over 3 lots ............................ $1,250
D All Others ............................................. $600 D Metes & Bounds (2 lots) ................... $300
D Interim Use Permit (IUP) D Consolidate Lots ............................ $150
D In conjunction with Single-Family Residence .... $400 D Administrative Subd. (Line Adjustment) ... $150
0 All Others ............................................. $600 0 Final Plat.. .................................. $500
D Rezoning (REZ) ........................................... $600 D Vacation of Easements/Right-of-way (VAC) ... $300
(Additional recording fees may apply)
~ Variance (VAR) ................................... $250
D PUD -Major/Minor Amendment
D Major Amendment to Existing PUD ................ $750
D Minor Amendment to Existing PUD ................ $100 D Wetland Alteration Permit (WAP)
D Site Plan Review (SPR) D Single-Family Residence ................... $150
D Administrative ........................................ $100 0 All Others .................................... $275
D Commercial/Industrial Districts .................... $750 D Appeal of Administrative Decision ............. $250
D Site Plan Agreement.. ................................... $500 D Zoning Ordinance Amendment (ZOA). ......... $500
D Amendment to Site Plan Agreement.. ............ $250 D Development Contract ......................... $500
D Development Review Escrow······················· .. $2,000 D Amendment to Development Contract.. .$250
Note: when multiple applications are processed concurrently, the appropriate fee shall be charged for each application.
[{J Notification Sign (city to install and remove) ............................................................................... $200
[{J Escrow for Recording Documents (check all that apply) .................................................... $ per document
D Conditional Use Permit.. .. $50 D Interim Use Permit.. ... $50 D Site Plan Agreement.. .. $85
D Wetland Alteration Permit.. ... $50 D Easements ( easements) .... $85 D Vacation ..... $85
~ Variance .... $50 D Metes & Bounds Sub (2 deeds) .... $250 D Deeds .... $100
D Plats & related documents .... $450 TOTALFEE:~14-5~0~.o-o-~
*Additional escrow may be required for additional recording and attorney's fees l of 4
$500.00
Docusign Envelope ID: C52 39BEC-ED00-8 3B4-8 328-ACF5F2EA942F
• DEVELOPMENT REVIEW APPLICATION
SECTION TWO: REQUIRED INFORMATION
Description of Proposal: Please see narrative attachment.
" Check box if separate
L{j narrative is attached
Property Address or Location : 6680 Lotus Trail, Chanhassen, MN 55317
Parcel#: 251600650
Legal Description: SECTION 01 TOWNSHIP 116 RANGE 023 CARVER BEACH LOTS 683 -688
Total Acreage: _o_.2_8 ____ _ Wetlands Present? Yes D No R:J
Present Land Use Designation : Residential Requested Land Use Designation : _n_/a ______ _
Existing use of Property : Residential Low Density
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Docusign Envelope ID: C52 39BEC-ED00-8 3B4-8 328-ACF5F2EA942F
• DEVELOPMENT REVIEW APPLICATION
SECTION THREE: PROPERTY OWNER & APPLICANT INFORMATION
APPLICANT OTHER THAN PROPERTY OWNER : In signing this application , I, as applicant, represent to have obtained
authorization from the property owner to file this application. I agree to be bound by conditions of approval, subject
only to the right to object at the hearings on the application or during the appeal period. If this application has
not been signed by the property owner. I have attached separate documentation of full legal capacity to file the
application . This application should be processed in my name and I am the party whom the city should contact
regarding any matter pertaining to this application. I will keep myself informed of the deadlines for submission of
material and the progress of this application. I further understand that additional fees may be charged for consulting
fees . feasibility studies. etc . with an estimate prior to any authorization to proceed with the study. I certify that the
information and exhibits submitted are true and correct.
Company: _________________ _ Contact Name: _________ _
Address: __________________ _ Phone : ___________ _
City/State/Zip : _______________ _ Cell: ___________ _
Email: ___________________ _
>>Signature: ______________ _ Date: _____ _
PROPERTY OWNER: In signing this application . I, as property owner . have full legal capacity to. and hereby do ,
authorize the filing of this application. I understand that conditions of approval are binding and agree to be bound by
those conditions . subject only to the right to object at the hearings or during the appeal periods. I will keep myself
informed of the deadlines for submission of material and the progress of this application. I further understand that
additional fees may be charged for consulting fees . feasibility studies. etc. with an estimate prior to any authorization
to proceed with the study. I certify that the information and exhibits submitted are true and correct.
Name: Elizabeth and Todd Williams Contact: _L_iz_W_il_lia_m_s ______ _
Address : 6680 Lotus Trail Phone: 612-500-8038 ------------
City/St ate/Zip : Chanhassen, MN 55317 Cell: _6_1_2-_5_0_0_-8_0_3_8 ______ _
Email : ___________________ _
» Signature [~~t!:tit [1)/Wa/\ts Date : 9/18/2026
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Docusign Envelope ID: C5239BEC-ED00-83B4-8328-ACF5F2EA942F
• DEVELOPMENT REVIEW APPLICATION
SECTION THREE: PROPERTY OWNER & APPLICANT INFORMATION (CONT.)
This application must be completed in full and be typewritten or clearly printed and must be
accompanied by all information and plans required by applicable City Ordinance provisions. Before filing
this application , refer to the appropriate Application Checklist and confer with the Planning Department
to determine the specific ordinance and applicable procedural requirements.
A determination of completeness of the application shall be made within 15 business days of application
submittal. A written notice of application deficiencies shall be mailed to the applicant within 15
business days of application.
PROJECT ENGINEER (if applicable)
Name: Omega Land-Care LLC
Address: 10112 Dupont Ave S
Bloomington, MN 55431
Contact: Willy Lozada
Phone: 952-688-1278
Cell: 952-688-1278
SECTION FOUR: NOTIFICATION INFORMATION
Who should receive copies of staff reports?
R'J Property Owner Email :
[lj Applicant Email: rarsenault@chanhassenmn.gov
[lj Engineer Email: ajandro@chanhassenmn.gov
[lj Other (list information below)
Name : Ryan Pinkalla
Email : rpinkalla@chanhassenmn.gov
Complete all necessary form fields , then select SAVE FORM to save a copy to your device or
PRINT FORM to print a physical copy . To SUBMIT YOUR APPLICATION, please send this form and all
associated documents to communit develo ment@chanhassenmn . ov or deliver them to City Hall.
TO BE COMPLETED BY CITY STAFF
APPLICATION FOR DEVELOPMENT REVIEW
Submittal Date: __ _ PC Date : __ _ CC Date : __ _ 60-Day Review Date: __ _
Planning Case Number ______ _
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