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City of Orono Conditional Use Permit Application Street Address: 2750 Keiley Parkway \\\ Orono, MN 55356 Main: 952-249-4600 fax' 952-249-4616 Mailing Address: P.O Box 66 Crystal Bay, MN 55323-0066 Application Date Received.- Staff eceived:Staff ; Fee: $lap Escrow. $700 / NA Notes: Please complete. Applicant will be notified within 15 days as to the status of the application. Incomplete applications will not be placed can Planning Commission Agendas. SITE LOCATION: `Z(P'-q K E-` L -L A-v,'E ©}LoNP Mf\) 553 I DESCRIPTION OF REQUEST: (�l F-" I N 6;t ", F i I- L -I N {c...-' - (attached additional sheets at necessary) APPLICANT INFORMATION: ❑ check Applicant: _3Q H N Phone (Primary): Oi Sze q Mailing Address: 4010 (D Email: c�r p -:;L- 9 if Applicant address should be used for billing RA " --, SONS _C1 i n r-, PROPERTY OWNER INFORMATION: ❑ check here if Property Owner is same as applicant ❑ check here if Property Owner adrirasc chni iltl ha .en,4 f-, tiM;i Name: Phone (Primary): Mailing Address: Email.- APPLICANT mail: a APPLICANT AND/OR PROPERTY OWNER: • Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and property owner recognize that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete or to recommend the request for denial of the request regardless of its potential merit. • The Property 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. • Property Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the Planning Commission and Council. If an applicant and/or property owner is unable to attend a scheduled meeting, please make arrangements to have an authorized representative attend in place of the applicant/owner and advise the City Planner assigned to your project. • Information will be distributed via email. Applicant Signature: Applicant Signature: Property Owner Signature: Property Owner Signature: CUP Application — January 2017 Page 4 Date: Date: Date: r/ G /?-- LL 7 Date: