Fillable Site Readiness Application (City of Farmington)

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Site Readiness Application (City of Farmington)

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Site Readiness Program
Grant Application
APPLICANT INFORMATION
NAME OF APPLICANT(S)
LAND OWNER
ADDRESS
CITY, STATE, ZIP
PHONE
EMAIL
OWNERSHIP INFORMATION
OWNERSHIP INTEREST OF ALL PARTIES NAMED ON TITLE:
NAME INTEREST
NAME INTEREST
NAME INTEREST
PROPERTY INFORMATION
ZONING: _____I-1 (INDUSTRIAL) ______ IP (INDUSTRIAL PARK)
____ B-1 (HIGHWAY BUSINESS) ______ B-3 (HEAVY BUSINESS)
____YES ____NO OWNERSHIP/TITLE CLEARED AND READY FOR SALE
____YES ____NO PROPER ZONING IN PLACE
____YES ____NO SURVEYS/STUDIES COMPLETED
1
____YES ____NO PERMITTING AGENCIES POSED FOR APPROVALS
____YES ____NO INFRASTRUCTURE WITHIN REASONABLE ACCESS
____YES ____NO COMPATIBLE ADJACENT LAND USE
____YES ____NO CONCEPTUAL SITE PLAN AND GENERAL COVENANTS
PROJECT INFORMATION
BRIEF DESCRIPTION OF PROPOSED PROJECT:
ESTIMATED PROJECT COSTS
TITLE WORK ESTIMATED COST
SURVEYS/STUDIES ESTIMATED COST
INFRASTRUCTURE ESTIMATED COST
SITE PLAN ESTIMATED COST
TOTAL ESTIMATED COST
2
FUNDING INFORMATION
A 1:1 match is required by the applicant. For every dollar contributed to funding eligible
project costs by the Site Readiness Program, the applicant must contribute at least one
dollar. The amount of grant to be awarded shall be up to $5,000.
TOTAL GRANT AMOUNT REQUESTED $ ___________
APPLICANT FUNDS $
I/We declare that the information provided on this application and the accompanying attachments is
true and complete to the best of my/our knowledge. I/We understand that any intentional
misstatements will be grounds for disqualification and that the city of Farmington / EDA has the right to
verify this information. I/We agree to provide the project coordinator reasonable access to information
and reasonable access to the construction project site so that they may monitor project
implementation.
APPLICANT(S)
DATE
DATE
DATE
3
MINNESOTA DATA PRACTICES ACT—TENNESSEN WARNING
In accordance with the State of Minnesota Government Data Practices Act, the city of
Farmington is required to inform you of your rights as they pertain to the confidential
information collected from you. Confidential data is that information which is not available to
you or the public. The personal information we collect about you is private.
The information collected from you and from other agencies or individuals is used to
determine the disposition of your application with the city.
The dissemination and use of the data collected is limited to that necessary for the
administration and management of the Site Readiness Program. Persons or agencies with
whom this information may be shared, include:
1. City of Farmington personnel administering the grant program
2. City Council members, Economic Development Authority members
3. Contracted private auditors
4. Law enforcement personnel
5. Those individuals or agencies to whom you give your express written
permission
NOTICE PURSUANT TO MS.60A.955
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Site Readiness Application (City of Farmington)

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Completed 15 July 2020

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