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City o Orono Conditional Use Permit Application StreetAddress. Application # 2750 Kelley Parkway Orono, MN 55356 Date Received staff Main: 952-249-4600 fax: 952-249-4616 Fee Mailing Address: Escrow # & $ P.0- Box 66 Crysial Bay, MN 55323-0066 Permit Fee Notes Please complete. Applicant will be notified within 15 days as to the status of the application. Incomplete applications will not be placed on Planning Commission Agendas. SITE LOCATION: �U,10 SHOF-Ekitit t�FIVE- 00,C) N 1) . A u !;SS APPLICANT I AGENT INFORMATION: Applicant Name: LAVILS-1, V 1041AIJO 6ILC+"lr MGT U Phone (Primary) U111. 11-+ - S116 . — Applicant Email: AAA M I Q 1AAAlre- I tA I I &MA - LOVA Address: _111b LZAat,L AVE 5 City: h&? L's, ZIP: 9 5!f Agent Name: Agent's phone number Agent Email: Applicant is: Contractor, Homeowner _�tILIC,tJ T.5 e -T PROPERTY OWNER INFORMATION: 0 check here if property owner is same as applicant Name: --MAILTViA MTMIP-S "L-A 2 Phone(Primary): __Ukl .1-10 ir le One) Mailing Address: I td I 1A W. VL ti 0 %T City: M F" ZIP: C;5$05 Email.- �AeAA V" 14tr!% & AV I - Lb v-,A- �J APPLICANTIAGENT AND/OR OWNER: 0 Agree to provide all information required or requested by the Planning Department, Agree to pay additional fees (staff time not covered in the original fee payment) and/or consultant expenses incurred in review of this application, and Certify that the information supplied is true and correct to the best of his/her knowledge, The applicant and owner recognize that they are solely responsible for submitting a complete application being aware that upon bilure to do so, the staff has no allArriative but to reject It until it is complete or to recommend the request for denial of the request regardless of its potential merit. * Acknowledge the Escrow Agreement is completed and signed. • The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification of this request. • 04er and/or Applicant acknowledge they must be present at all scheduled review meetings of the Planning Commission and Council. If an applicant and/or owner is unable to attend a scheduled meeting, please make arrangements to have an authorized representative attend in place of the applicanVowner and advise the City Planner assigned to your project. Applicant/Agent Signature: —Date: 4 17� Applicant/Agent Signature: Date: Property Owner 5�fgnature-�-MAA Petl YA - f f --F 18 T_ Property Owner Signature: Date: CUP Application - January 2016 RECEIVED Page 2 JAN 18 2017 C TY OF ORONO # 3905