97-640Council File # ��b4b
ordinance #
Green Sheet # 3✓ '3O2 �
Presented By �
Referred To
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Com[aittee: Date
:
1
2
3
RE5QLVED: T'�at application (ID #31040) for a Gas Station, Resta�ant-C, Grocery-C, and Cigazette License by
Super America Group Division of Ashland DBA SuperAmerica #4040 (Greg Boland, Manager) at
1171 Old Hudson Road be and the same is hereby approved.
4
5 Requeated by Department ofs
6 Yeas Navs se
7 B a�kev — ��
8 Bostrom ��
9 _ � H � a r r s
10 _e�e ao rd �
11 �em�ri.ot�;,�s =___;�
12 Thane
14 Moz�ton S O �
15
16 Adopted by Council: IIate t
17
18 Adoption Certi£ied by Council Secretary
19
20 \
21 By: �,..-----����v._`�ai.�_„_�--
22 �
23 Approved by Mayor: Date �� }-
24 �/ , `
2s �����
26 By: t
27
• - -�-- �-•- •�- -�.�
�. •�.n-: - •:
By: \ �N'�d�W � �'�4.u"l-/
Form Approved by City Attorney
By:
Approved�by Mayor for Su6mission to
Council
By:
��: b�lU
DEPARTMENT/OFFICElCOUNCIL OATEINITIATED GREEN SHEE N_ 35321
LIEP/Licensin Mmnuon.r� -- iNmawa
COMACT PEflSON 8 PHONE O DEPARTMEM DIflECTOfl � CfTY COUNCIL
Christine Rozek, 266-9108 ''�'�" �crzvarmaNer �crtrc�wc
MU5T BE ON C/JUNGL AGENflA BY DAT NUYBER FOR
S Q E�� ROUi1NG O��ET DIRECTOR � FIN. & MC+T. SERVICES DIR.
For hearin :
�`Z V 1� ORDER O MAYqi lOA ASSSTANS) O
TOTAL # OF SIGNATUpE PAGES (CLIP ALL LOCA710NS FOR SIGNATUH�
ACfION REOUESTED:
The SuperAmerica Group Division of Ashland DBA SuperAmerica 9i4040 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License
located at 1771 Old Hudson Road (ID //31040).
RECOMMENDATIONS: apqwe (A) ar Reject (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING DUES'f10N5:
_ PLANNING GOMMISSION _ CML SERVICE COMMISSION �- Has this persoNfirm ever woriced untler a conVac[ ior this departmeM? -
_ CIB COMMI7iEE _ YES NO
_ STA� 2. Has this perso�rm ever been a city employee?
— YES NO
_ DISiRiC7 CoUp7 _ 3. Does thts person/firm possess a skill not normalty possessetl by any current city employee?
SUPPORTS WNICH COUNCIL OBJECTNE7 YES NO
Explain ell yes answers on separate sheet antl attaeh to green shcet
INITIATINO PFiOBLEM, ISSUE, OPPORTUNIN (Who, What, When. Where, Why):
ADUANTAGESIFAPPROVED:
DISADVANTACaES IGAPPROVED:
4Yi3bii'v�iY �?�RT.�,^ ,'y,,.4,''
��'ift� �� tw5�i
DISADVANTAGES IF NOT APPROYEO:
TOTAL AMOUNT OF TqANSACTION $ COSTIREVENUE BUDGETED (CIRCLE Ot4E) VES NO
FUNDING SOUqCE ACiIVITY NUMBER
FINANCIPLINFORMATION:(EXPLAIN)
Greensheet # 35321 L.I.E.P. REVIEW CHECKLIST Date: 3/27/97 r`�1
In Tracker? App n Received J npp�n �rocessea
LiCenselD # 31040 License Type_Gas Station Restaurant-C. Grocery- . and c; r.;cez
COmpany Name: SunerAmerica Grouo Div�s�on of Achiand DBA: SuperAmerica ��4040
BUSiness AddressS: 1771 Old Hudson Road Business Phone: 776-8580
Contact NamejAddress: Greg Boland, 1771 Old Hudson Road Home Phone:
Date to Council Researcfi: 55106
Public Hearing Date: � 28 � La6els Ordered:
Notice SeM to Applicant: � District Council #: `
Notice Sent to
��f � � a ��� � Ward #:
Date
Comments
Department/
City Attorney
Environmental
Heaith
Fire
�,
��� •
��
License
�� V� /�
i
Police
Zoning
D•�.
Site Plen Received:_
Lease Received: - - - -
�/� � �
� (�
o -�
��lo�q �- f p - K
MpR-19-1997 11�08 CITY OF ST PAUL LIEP 612 266 9124 P.02/96
$n1A{�
1 F.iVL�
.���
C�.ASS TJI
LICENSE APPLICA'TION
A 1 -�ir .
CITY OF SAINT PAl
a���u�,r�a;�
���
3'bSt4eaR5me�00
� '/� � � SesPu��Rt+�soa 351a1
{� /y�/y/f/�� ��1 � �p.V� ( �/��I 1 -- t `��� ��266.9090fa(61t)26691]d
T1 e �vs a
�trS apui.r���i�, � � �������� s �
PLEASE'£YPE OR PRTNT Ic1 ItdK �
�
Compffiy Name:
t So7c PropnctasLip
ff business is incotpocata3, giva date of incoiparxtiou;
27oing ausiness as: �1 SA '�.'� � A Y�t•t R �
�
so-«c.nasras
Betwan What ccnss s�eeta is the busaess located7
Are thc premises now occupied7 �Vhat
Mail To Ad�ess:
C+'.T�7:R�.'."n
s �f�-/
s � . �,� p U
s
s
P
�-aa� -36
Business Imone.�O1L-774� b F d
,T� sl a/ iy � SSic 6
c;�y sum z�
WI1iCd1 SidC OCIllG ShtY`L�
i N�,'t �.� �ti yosiZ
CitY Sretc z^P
AppGea�u laformafi�:
N��T�u�: �,�i���uzZ,���.� C�.�,�.s FA,��;�a1 �-
F'vu l�fid�c (hSaidn) Lmt Tt7e
T
xo� Aaat�: P C► Q!/�,-��U d - -
�� �m � �
Date of Birth: 1 �.. �- l� � Plxce of $irth: Home Phone:la6 f. 3� z 1.�
Have yoa ever been comdcud of anp feTony, aima or violation of any aty ordinance other thaa 4affic? YES _ NO �_
Date of arrest;
Chargc: �„
Coavictiou: _
4d�ere7
,. .....
S.ia ti�cnames andnsidences of three petsons o€good moral charactcr, &ving within the Twin CiGes Metro Atea, noi relattd to the apglicant
or fin�cial}y interested "m the premises or business, who may be rcfared to as io the applicauY's cl�aracter:
� .��
Have a�'of tke above named
ADDRESS
.t S - 1 `17.
�
ld, frnmtrly b¢ld, or m
e3�� e�
0 -yaN D STS • � �
�, s� N w - :
�t a
kave aa i7ltei�CSt in: � _
PHONE
� •�; 7
�a • b33- �y
2-
YES � NO If ycs, list tiu data svd ressons #'or revacaUOa:
2/18/9'I
-19-1997 11:08 CITY OF ST PAUL LIEP 612 266 9124 P.04i06
� �-1.'1-tG»�kb
8�€ :o operetc this business pcsonaU�•? YES � NO If not, �rho wiU opaxte �'tIPER AAiE2tICAG�4:Ilz
.�..--:
�
cP�.
{uecaago�gtor,z�ran�z3erore5s:statinthisbuiaess? YES
plezsc canplete cfie folla�ing in.`amzuoa:
�ji 2Cn h �6NOf —
Fi�s\sme 1Sd2fe7aAa1 G�im3.-�
�2�t Dld ��cd so�► /2d ST ,ay
i;oc�aaam s�+�� , ��Y
PJerse fistyour emplocmcal histozy fos stie pre��o,u 5ve {>} cezr p�od:
Bus+�esslEt�7rn�tnt Address
�,:�
:SO If the msaxg� is ncrt Sh� s2me €s tbe rn� etator,
z;�
info:madan fac eaeh parma (use addiuonal paga if necessaryj:
(.wdausl � i..a Det`
Ho�eMdre� Svees\eme Citv Svue tip Phaneh5cba
Fcat\amt AfiddfeIuisis! (.�Saidea) I.ut Da+eef8iesh
Have.4dd�'us: Sma:+�me Cary Stste Zip Phox!�5mbet
MINIdESO7A 1'AX IDENl7FICA?ION NL�I�lBER - Pu�vaat to s2�e Law's of Mianesota,1984, Chapter 562,.4rficSe 8, Section 2(270.72)
(?a� Clwrance; � of Liceaxs), &ansing auehorities ere req�ed to pmvide to tt�e State of Mmnesvta Commissioner ofRcvcauq tfie
3�Gaxsota busiaess t�c i���4on numbu and tbe socisl securiry aumber of cach 7�� applicant
Uuder the Nfinaesota Gwecmnmt Data Pracrices Aa �d s}x Fedaat Pricacg Act af 197Q, we ffie requ�red to advise you oftho follow�g
regard'mg the use of the Mumesofa T� Identification Num'xr.
- Zbis inf�matian maq be us�d to dmp tSu issuana or reaewsl of yocff licrose in t6e cvcat you owe M�nnesota sales, employa s
witbfioldmg or mMoc vehicle acase twccs;
-1JF°n r�i�'�S t�s i�a�msaon, tbe liceasiag autL�iry w�! supply it oaIy to the Mwaesoaa DePaztment of Revmeu. However,
unda che Fedaal Exc��tgc af iuformation A�mmt, tbe DeP�tmcnt of Reveaue maY �'PPtY this iuf'ormation to tIK Iaternal
Rev�ue Scvicm .
A� Taxl�ti5cetidaNnmbes (Sates &i3se Tax Numbc)mag ba obtaine� T� tl� State of l�� Busincss R�cords DeP�tm�.
20RivaParkPiaza(612-296-6181� --..... /-�� `
s��s��yx��; ��� l- � I��-a'S G _ MmnesoWTaxTdentiSeatianNum'ba:: `�`7r�[,'�JS _
^ lf a Mmnesota Tex Identificauou Nwnba is aot roquired for the bvs;nas being operated, iadicau so by plsciag aa'X' ia � twx
encn�
List zll otha o+�eas of the o�pa: etion:
O �� �.� H0� k30.�,£ BUSL'�*ESS DATE OF
;�*A.e� (p�aHe�I) � ADT�S5 PHO�'E PHOATE BIRTH
Council File # ��b�b
ordinance #
Green Sheet # 3✓ '3O2 �
Presented By �
Referred To
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Com[aittee: Date
:
1
2
3
RE5QLVED: T'�at application (ID #31040) for a Gas Station, Resta�ant-C, Grocery-C, and Cigazette License by
Super America Group Division of Ashland DBA SuperAmerica #4040 (Greg Boland, Manager) at
1171 Old Hudson Road be and the same is hereby approved.
4
5 Requeated by Department ofs
6 Yeas Navs se
7 B a�kev — ��
8 Bostrom ��
9 _ � H � a r r s
10 _e�e ao rd �
11 �em�ri.ot�;,�s =___;�
12 Thane
14 Moz�ton S O �
15
16 Adopted by Council: IIate t
17
18 Adoption Certi£ied by Council Secretary
19
20
21 By: �,..-----���� %�-a-.,.tir—
22 �
23 Approved by Mayor: Date �� }-
24 �/ , `
2s �����
26 By: t
27
• - -�-- �-•- •�- -�.�
�. •�.n-: - •:
By: \ �N'�d�W � �'�4.u"l-/
Form Approved by City Attorney
By:
Approved�by Mayor for Su6mission to
Council
By:
��: b�lU
DEPARTMENT/OFFICElCOUNCIL OATEINITIATED GREEN SHEE N_ 35321
LIEP/Licensin Mmnuon.r� -- iNmawa
COMACT PEflSON 8 PHONE O DEPARTMEM DIflECTOfl � CfTY COUNCIL
Christine Rozek, 266-9108 ''�'�" �crzvarmaNer �crtrc�wc
MU5T BE ON C/JUNGL AGENflA BY DAT NUYBER FOR
S Q E�� ROUi1NG O��ET DIRECTOR � FIN. & MC+T. SERVICES DIR.
For hearin :
�`Z V 1� ORDER O MAYqi lOA ASSSTANS) O
TOTAL # OF SIGNATUpE PAGES (CLIP ALL LOCA710NS FOR SIGNATUH�
ACfION REOUESTED:
The SuperAmerica Group Division of Ashland DBA SuperAmerica 9i4040 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License
located at 1771 Old Hudson Road (ID //31040).
RECOMMENDATIONS: apqwe (A) ar Reject (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING DUES'f10N5:
_ PLANNING GOMMISSION _ CML SERVICE COMMISSION �- Has this persoNfirm ever woriced untler a conVac[ ior this departmeM? -
_ CIB COMMI7iEE _ YES NO
_ STA� 2. Has this perso�rm ever been a city employee?
— YES NO
_ DISiRiC7 CoUp7 _ 3. Does thts person/firm possess a skill not normalty possessetl by any current city employee?
SUPPORTS WNICH COUNCIL OBJECTNE7 YES NO
Explain ell yes answers on separate sheet antl attaeh to green shcet
INITIATINO PFiOBLEM, ISSUE, OPPORTUNIN (Who, What, When. Where, Why):
ADUANTAGESIFAPPROVED:
DISADVANTACaES IGAPPROVED:
4Yi3bii'v�iY �?�RT.�,^ ,'y,,.4,''
��'ift� �� tw5�i
DISADVANTAGES IF NOT APPROYEO:
TOTAL AMOUNT OF TqANSACTION $ COSTIREVENUE BUDGETED (CIRCLE Ot4E) VES NO
FUNDING SOUqCE ACiIVITY NUMBER
FINANCIPLINFORMATION:(EXPLAIN)
Greensheet # 35321 L.I.E.P. REVIEW CHECKLIST Date: 3/27/97 r`�1
In Tracker? App n Received J npp�n �rocessea
LiCenselD # 31040 License Type_Gas Station Restaurant-C. Grocery- . and c; r.;cez
COmpany Name: SunerAmerica Grouo Div�s�on of Achiand DBA: SuperAmerica ��4040
BUSiness AddressS: 1771 Old Hudson Road Business Phone: 776-8580
Contact NamejAddress: Greg Boland, 1771 Old Hudson Road Home Phone:
Date to Council Researcfi: 55106
Public Hearing Date: � 28 � La6els Ordered:
Notice SeM to Applicant: � District Council #: `
Notice Sent to
��f � � a ��� � Ward #:
Date
Comments
Department/
City Attorney
Environmental
Heaith
Fire
�,
��� •
��
License
�� V� /�
i
Police
Zoning
D•�.
Site Plen Received:_
Lease Received: - - - -
�/� � �
� (�
o -�
��lo�q �- f p - K
MpR-19-1997 11�08 CITY OF ST PAUL LIEP 612 266 9124 P.02/96
$n1A{�
1 F.iVL�
.���
C�.ASS TJI
LICENSE APPLICA'TION
A 1 -�ir .
CITY OF SAINT PAl
a���u�,r�a;�
���
3'bSt4eaR5me�00
� '/� � � SesPu��Rt+�soa 351a1
{� /y�/y/f/�� ��1 � �p.V� ( �/��I 1 -- t `��� ��266.9090fa(61t)26691]d
T1 e �vs a
�trS apui.r���i�, � � �������� s �
PLEASE'£YPE OR PRTNT Ic1 ItdK �
�
Compffiy Name:
t So7c PropnctasLip
ff business is incotpocata3, giva date of incoiparxtiou;
27oing ausiness as: �1 SA '�.'� � A Y�t•t R �
�
so-«c.nasras
Betwan What ccnss s�eeta is the busaess located7
Are thc premises now occupied7 �Vhat
Mail To Ad�ess:
C+'.T�7:R�.'."n
s �f�-/
s � . �,� p U
s
s
P
�-aa� -36
Business Imone.�O1L-774� b F d
,T� sl a/ iy � SSic 6
c;�y sum z�
WI1iCd1 SidC OCIllG ShtY`L�
i N�,'t �.� �ti yosiZ
CitY Sretc z^P
AppGea�u laformafi�:
N��T�u�: �,�i���uzZ,���.� C�.�,�.s FA,��;�a1 �-
F'vu l�fid�c (hSaidn) Lmt Tt7e
T
xo� Aaat�: P C► Q!/�,-��U d - -
�� �m � �
Date of Birth: 1 �.. �- l� � Plxce of $irth: Home Phone:la6 f. 3� z 1.�
Have yoa ever been comdcud of anp feTony, aima or violation of any aty ordinance other thaa 4affic? YES _ NO �_
Date of arrest;
Chargc: �„
Coavictiou: _
4d�ere7
,. .....
S.ia ti�cnames andnsidences of three petsons o€good moral charactcr, &ving within the Twin CiGes Metro Atea, noi relattd to the apglicant
or fin�cial}y interested "m the premises or business, who may be rcfared to as io the applicauY's cl�aracter:
� .��
Have a�'of tke above named
ADDRESS
.t S - 1 `17.
�
ld, frnmtrly b¢ld, or m
e3�� e�
0 -yaN D STS • � �
�, s� N w - :
�t a
kave aa i7ltei�CSt in: � _
PHONE
� •�; 7
�a • b33- �y
2-
YES � NO If ycs, list tiu data svd ressons #'or revacaUOa:
2/18/9'I
-19-1997 11:08 CITY OF ST PAUL LIEP 612 266 9124 P.04i06
� �-1.'1-tG»�kb
8�€ :o operetc this business pcsonaU�•? YES � NO If not, �rho wiU opaxte �'tIPER AAiE2tICAG�4:Ilz
.�..--:
�
cP�.
{uecaago�gtor,z�ran�z3erore5s:statinthisbuiaess? YES
plezsc canplete cfie folla�ing in.`amzuoa:
�ji 2Cn h �6NOf —
Fi�s\sme 1Sd2fe7aAa1 G�im3.-�
�2�t Dld ��cd so�► /2d ST ,ay
i;oc�aaam s�+�� , ��Y
PJerse fistyour emplocmcal histozy fos stie pre��o,u 5ve {>} cezr p�od:
Bus+�esslEt�7rn�tnt Address
�,:�
:SO If the msaxg� is ncrt Sh� s2me €s tbe rn� etator,
z;�
info:madan fac eaeh parma (use addiuonal paga if necessaryj:
(.wdausl � i..a Det`
Ho�eMdre� Svees\eme Citv Svue tip Phaneh5cba
Fcat\amt AfiddfeIuisis! (.�Saidea) I.ut Da+eef8iesh
Have.4dd�'us: Sma:+�me Cary Stste Zip Phox!�5mbet
MINIdESO7A 1'AX IDENl7FICA?ION NL�I�lBER - Pu�vaat to s2�e Law's of Mianesota,1984, Chapter 562,.4rficSe 8, Section 2(270.72)
(?a� Clwrance; � of Liceaxs), &ansing auehorities ere req�ed to pmvide to tt�e State of Mmnesvta Commissioner ofRcvcauq tfie
3�Gaxsota busiaess t�c i���4on numbu and tbe socisl securiry aumber of cach 7�� applicant
Uuder the Nfinaesota Gwecmnmt Data Pracrices Aa �d s}x Fedaat Pricacg Act af 197Q, we ffie requ�red to advise you oftho follow�g
regard'mg the use of the Mumesofa T� Identification Num'xr.
- Zbis inf�matian maq be us�d to dmp tSu issuana or reaewsl of yocff licrose in t6e cvcat you owe M�nnesota sales, employa s
witbfioldmg or mMoc vehicle acase twccs;
-1JF°n r�i�'�S t�s i�a�msaon, tbe liceasiag autL�iry w�! supply it oaIy to the Mwaesoaa DePaztment of Revmeu. However,
unda che Fedaal Exc��tgc af iuformation A�mmt, tbe DeP�tmcnt of Reveaue maY �'PPtY this iuf'ormation to tIK Iaternal
Rev�ue Scvicm .
A� Taxl�ti5cetidaNnmbes (Sates &i3se Tax Numbc)mag ba obtaine� T� tl� State of l�� Busincss R�cords DeP�tm�.
20RivaParkPiaza(612-296-6181� --..... /-�� `
s��s��yx��; ��� l- � I��-a'S G _ MmnesoWTaxTdentiSeatianNum'ba:: `�`7r�[,'�JS _
^ lf a Mmnesota Tex Identificauou Nwnba is aot roquired for the bvs;nas being operated, iadicau so by plsciag aa'X' ia � twx
encn�
List zll otha o+�eas of the o�pa: etion:
O �� �.� H0� k30.�,£ BUSL'�*ESS DATE OF
;�*A.e� (p�aHe�I) � ADT�S5 PHO�'E PHOATE BIRTH
Council File # ��b�b
ordinance #
Green Sheet # 3✓ '3O2 �
Presented By �
Referred To
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Com[aittee: Date
:
1
2
3
RE5QLVED: T'�at application (ID #31040) for a Gas Station, Resta�ant-C, Grocery-C, and Cigazette License by
Super America Group Division of Ashland DBA SuperAmerica #4040 (Greg Boland, Manager) at
1171 Old Hudson Road be and the same is hereby approved.
4
5 Requeated by Department ofs
6 Yeas Navs se
7 B a�kev — ��
8 Bostrom ��
9 _ � H � a r r s
10 _e�e ao rd �
11 �em�ri.ot�;,�s =___;�
12 Thane
14 Moz�ton S O �
15
16 Adopted by Council: IIate t
17
18 Adoption Certi£ied by Council Secretary
19
20
21 By: �,..-----���� %�-a-.,.tir—
22 �
23 Approved by Mayor: Date �� }-
24 �/ , `
2s �����
26 By: t
27
• - -�-- �-•- •�- -�.�
�. •�.n-: - •:
By: \ �N'�d�W � �'�4.u"l-/
Form Approved by City Attorney
By:
Approved�by Mayor for Su6mission to
Council
By:
��: b�lU
DEPARTMENT/OFFICElCOUNCIL OATEINITIATED GREEN SHEE N_ 35321
LIEP/Licensin Mmnuon.r� -- iNmawa
COMACT PEflSON 8 PHONE O DEPARTMEM DIflECTOfl � CfTY COUNCIL
Christine Rozek, 266-9108 ''�'�" �crzvarmaNer �crtrc�wc
MU5T BE ON C/JUNGL AGENflA BY DAT NUYBER FOR
S Q E�� ROUi1NG O��ET DIRECTOR � FIN. & MC+T. SERVICES DIR.
For hearin :
�`Z V 1� ORDER O MAYqi lOA ASSSTANS) O
TOTAL # OF SIGNATUpE PAGES (CLIP ALL LOCA710NS FOR SIGNATUH�
ACfION REOUESTED:
The SuperAmerica Group Division of Ashland DBA SuperAmerica 9i4040 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License
located at 1771 Old Hudson Road (ID //31040).
RECOMMENDATIONS: apqwe (A) ar Reject (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING DUES'f10N5:
_ PLANNING GOMMISSION _ CML SERVICE COMMISSION �- Has this persoNfirm ever woriced untler a conVac[ ior this departmeM? -
_ CIB COMMI7iEE _ YES NO
_ STA� 2. Has this perso�rm ever been a city employee?
— YES NO
_ DISiRiC7 CoUp7 _ 3. Does thts person/firm possess a skill not normalty possessetl by any current city employee?
SUPPORTS WNICH COUNCIL OBJECTNE7 YES NO
Explain ell yes answers on separate sheet antl attaeh to green shcet
INITIATINO PFiOBLEM, ISSUE, OPPORTUNIN (Who, What, When. Where, Why):
ADUANTAGESIFAPPROVED:
DISADVANTACaES IGAPPROVED:
4Yi3bii'v�iY �?�RT.�,^ ,'y,,.4,''
��'ift� �� tw5�i
DISADVANTAGES IF NOT APPROYEO:
TOTAL AMOUNT OF TqANSACTION $ COSTIREVENUE BUDGETED (CIRCLE Ot4E) VES NO
FUNDING SOUqCE ACiIVITY NUMBER
FINANCIPLINFORMATION:(EXPLAIN)
Greensheet # 35321 L.I.E.P. REVIEW CHECKLIST Date: 3/27/97 r`�1
In Tracker? App n Received J npp�n �rocessea
LiCenselD # 31040 License Type_Gas Station Restaurant-C. Grocery- . and c; r.;cez
COmpany Name: SunerAmerica Grouo Div�s�on of Achiand DBA: SuperAmerica ��4040
BUSiness AddressS: 1771 Old Hudson Road Business Phone: 776-8580
Contact NamejAddress: Greg Boland, 1771 Old Hudson Road Home Phone:
Date to Council Researcfi: 55106
Public Hearing Date: � 28 � La6els Ordered:
Notice SeM to Applicant: � District Council #: `
Notice Sent to
��f � � a ��� � Ward #:
Date
Comments
Department/
City Attorney
Environmental
Heaith
Fire
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License
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Police
Zoning
D•�.
Site Plen Received:_
Lease Received: - - - -
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MpR-19-1997 11�08 CITY OF ST PAUL LIEP 612 266 9124 P.02/96
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Compffiy Name:
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ff business is incotpocata3, giva date of incoiparxtiou;
27oing ausiness as: �1 SA '�.'� � A Y�t•t R �
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Betwan What ccnss s�eeta is the busaess located7
Are thc premises now occupied7 �Vhat
Mail To Ad�ess:
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Date of Birth: 1 �.. �- l� � Plxce of $irth: Home Phone:la6 f. 3� z 1.�
Have yoa ever been comdcud of anp feTony, aima or violation of any aty ordinance other thaa 4affic? YES _ NO �_
Date of arrest;
Chargc: �„
Coavictiou: _
4d�ere7
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S.ia ti�cnames andnsidences of three petsons o€good moral charactcr, &ving within the Twin CiGes Metro Atea, noi relattd to the apglicant
or fin�cial}y interested "m the premises or business, who may be rcfared to as io the applicauY's cl�aracter:
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Have a�'of tke above named
ADDRESS
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YES � NO If ycs, list tiu data svd ressons #'or revacaUOa:
2/18/9'I
-19-1997 11:08 CITY OF ST PAUL LIEP 612 266 9124 P.04i06
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8�€ :o operetc this business pcsonaU�•? YES � NO If not, �rho wiU opaxte �'tIPER AAiE2tICAG�4:Ilz
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{uecaago�gtor,z�ran�z3erore5s:statinthisbuiaess? YES
plezsc canplete cfie folla�ing in.`amzuoa:
�ji 2Cn h �6NOf —
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i;oc�aaam s�+�� , ��Y
PJerse fistyour emplocmcal histozy fos stie pre��o,u 5ve {>} cezr p�od:
Bus+�esslEt�7rn�tnt Address
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:SO If the msaxg� is ncrt Sh� s2me €s tbe rn� etator,
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info:madan fac eaeh parma (use addiuonal paga if necessaryj:
(.wdausl � i..a Det`
Ho�eMdre� Svees\eme Citv Svue tip Phaneh5cba
Fcat\amt AfiddfeIuisis! (.�Saidea) I.ut Da+eef8iesh
Have.4dd�'us: Sma:+�me Cary Stste Zip Phox!�5mbet
MINIdESO7A 1'AX IDENl7FICA?ION NL�I�lBER - Pu�vaat to s2�e Law's of Mianesota,1984, Chapter 562,.4rficSe 8, Section 2(270.72)
(?a� Clwrance; � of Liceaxs), &ansing auehorities ere req�ed to pmvide to tt�e State of Mmnesvta Commissioner ofRcvcauq tfie
3�Gaxsota busiaess t�c i���4on numbu and tbe socisl securiry aumber of cach 7�� applicant
Uuder the Nfinaesota Gwecmnmt Data Pracrices Aa �d s}x Fedaat Pricacg Act af 197Q, we ffie requ�red to advise you oftho follow�g
regard'mg the use of the Mumesofa T� Identification Num'xr.
- Zbis inf�matian maq be us�d to dmp tSu issuana or reaewsl of yocff licrose in t6e cvcat you owe M�nnesota sales, employa s
witbfioldmg or mMoc vehicle acase twccs;
-1JF°n r�i�'�S t�s i�a�msaon, tbe liceasiag autL�iry w�! supply it oaIy to the Mwaesoaa DePaztment of Revmeu. However,
unda che Fedaal Exc��tgc af iuformation A�mmt, tbe DeP�tmcnt of Reveaue maY �'PPtY this iuf'ormation to tIK Iaternal
Rev�ue Scvicm .
A� Taxl�ti5cetidaNnmbes (Sates &i3se Tax Numbc)mag ba obtaine� T� tl� State of l�� Busincss R�cords DeP�tm�.
20RivaParkPiaza(612-296-6181� --..... /-�� `
s��s��yx��; ��� l- � I��-a'S G _ MmnesoWTaxTdentiSeatianNum'ba:: `�`7r�[,'�JS _
^ lf a Mmnesota Tex Identificauou Nwnba is aot roquired for the bvs;nas being operated, iadicau so by plsciag aa'X' ia � twx
encn�
List zll otha o+�eas of the o�pa: etion:
O �� �.� H0� k30.�,£ BUSL'�*ESS DATE OF
;�*A.e� (p�aHe�I) � ADT�S5 PHO�'E PHOATE BIRTH