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City of Orono <br />Conditional Use Permit Application PC Exhibit A <br />StreetAddress: Applicabon # /7-39/e <br />2750 Kelley Parkway <br />Orono, MN 55356 Date Received- 07-ao <br />staff <br />Main: 952-249-4600 <br />mx: 952-249-4616 Fee- $700 <br />Mailing Address: Escrow $700 / NA <br />P.O. Box 66 <br />Crystal Bay, MN 55323-0066 Notes <br />tslio <br />Please complete. Applicant will be notified within 15 days as to the status of the application. <br />Incomplete applications will not be placed on Planning Commission Agendas. <br />SITE LOCATION: <br />/?//p <br />DESCRIPTION OF REQUEST: %_ L^ <br />Lo- //'xq al <br />(attached adeftionbi sheets aft necess-ary) <br />APPLICANT INFORMATION: Wc-heck here if Applicant address should be used for billing <br />Applicant: haep .5 1 - <br />Phone (Primary): <br />ZIP: <br />4m, <br />Mailing Address: <br />Email: Af_'fy-44-Xra fi, 4"I't <br />PROPERTY OWNER INFORMATION: U-c'heck here if Property Owner is same as applicant <br />Name: heck here if Property Owner address should be used for billing <br />Phone (Primary): <br />Mailing Address: City ZIP: <br />Email: fl) I III i "I'q V" -.1A I A e-1 I'V I i I m� i j, <br />APPLICANT AND/OR PROPERTY OWNER: <br />• Certify that the information supplied is true and correct to the best of hisiher knowledge. The applicant and property <br />owner recognize that they are solely responsible for submitting a complete application being aware that upon <br />failure to do so, the staff has no alternative but to reject it until it is complete or to recommend the request for <br />denial of the request regardless of its potential merit. <br />• The Property Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the <br />property by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification <br />of this request. <br />Property Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the <br />Planning Commission and Council. If an applicant and/or property owner is unable to attend a scheduled meeting, <br />please make arrangements to have an authorized representative attend in place of the applicant/owner and advise the City <br />Planner assigned to your project. <br />Information will be distributed via,@mi <br />Applicant Signature: <br />Applicant Signature: <br />Property Owner Signature: <br />Property Owner Signature: <br />CUP Application - January 2017 <br />Page 4 <br />Date: <br />Date: <br />Date: <br />Date: <br />RECEIVED <br />FEB 2 12017 <br />#3910 CVTY OF ORONO <br />