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City of Orono Conditional Use Permit Application PC Exhibit A 2750 Kelley Parimay Application # 17-39.1140 Orono, MN 56356 1 Date Received 07-.74-.4 Maln. 952,249-000 staff fax 952-24"816 Fee $700 MROVAdftsw P.O. Box 56 Escrow. $700 / NA Crys1lal Bay. MN 553234006 Nobe Please complete. Applicant Y49 be notffled vAthin 15 days as to the staWs of the application. Incomplete applicarUons vAll DA be placed on Planning Commission Agendas. SITELOCATION: 324!�-Wayo-k-Vw, Okoko AdAlr-559-p DESCRIPTION OF REQUEST: sheeft APPLICANT INFORMATION: PtImck here If ApplicaM address should be used for bIlling Applicant, Ad Lw.,� Phone (Pdrnary): 113= MallIng Address: Aaaaqz sa-4 11 gy R&A[72-107- Email: dfotEa- [fA IgE5bdeyr. /Frlog elftuo Y. 0011 PROPERTY OWNER INFORMATION: Mfh'eck here If Property Owner Is same as applicant 13 check here If Property Owner address should be uwd fbr billing Name: 6a UX4 lie Phone (Primary): 93Q-.aX%7) Malling Address: WEI; z &a A U lav �5 C i t) rL1 11A 2 - ZIP: . - K Emall: AnA APPLICANT ANDIOR PROPERTY OWNER. • Certify that the Inforinallon supplied Is true and co"sd to ft beg of his/her knmMedgG. The applicant and property owner moognize tW they are solely responsible for submlWng a cOmP1616 aPpllwWon being aware that upon failure to do so, the staff has no afternarthre but to rood It until It Is c*MPIGW of to recommend the request for denial of the request regaridless of its potential medt, • The Property Owner hereby acknowledges and agmes to this application and further authorizes reasonable entry onto the prop" by City SUff, consultants, agents. Commission and Coundt Mernbars for purposes of Investigation and ver1fication of this request. • Property Owner andfor Appilicant acknowledge they must be present at all schodulad review meetings of the Planning Commission and Council. If an applicant and/or property owner Is unable to aftend a scheduled mWing, please make arrangements to hmm an sulhodzed mpresenbdive attend in place of the applicantlawner and advise the City Planner assigned to your project. Information vAll be distributed via arnall. Applicant Signature: .11 oef�'- App[Icant Signature: Property Owner Signature: Property Owner Signature: CUP Appkathn - Jenuwy 2017 Page 4 Date: Date: Date: iul-& anq Date: RECEIVED FS 2 12017 #3910 crffof�ORONO