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<br /> - City of CJrc�no
<br /> Subdivisiorr ,Appli�ation
<br /> StreetAddress: Application# 05 "J�b l
<br /> �Q� 2750 Kelley Parkway Date Received: U /g OS
<br /> Orono, MN 55356 Amount Paid: �Jpp, ��
<br /> � L� � Staff: ✓/l'NICC"
<br /> ��?���,,� Main: 952-249-4600 Fee:
<br /> � 4`,-%�';;���r �+ fax: 952-249-4616 Renewal:
<br /> �� �� ' '"�y ��`� Mailing Address:
<br /> �9kEsHo�"� p•O. Box 66
<br /> Crystal Bay, MN 55323-0066
<br /> This application form must be compieted in full.
<br /> PROPERTY INFORMATION:
<br /> Site Address: �8 � c7rf�t Sl,ore . o � ��j 3�`/� 3;' tv �k S�" •3 GiSNorl�slco�
<br /> Property Identification Number(PIN): �7_���_23_ �2-000 -oo �'u"ds's:
<br /> (Attach �egal description to application if not included on the survey. " � ,
<br /> Date Property Acquired (month/year): ❑ Abstract or�Torrens, please check one
<br /> Present use of property: �Residential ❑ Other
<br /> Zoning District: (^�_ ��
<br /> APPLICANT INFORMATIQN: (Complete legal names and marital status required for each interested party)
<br /> Name: Jq.re�1. �,,.ar
<br /> Phone (home): Phone (work): ��3 Zy- �'sp�'
<br /> Address: �2op �/�,, Lti �TE �d�
<br /> Email: "' •o,.K, oc�c� .�,.,Fax: 763-�f2�--5�2Z
<br /> OWNER INFORMATION: (Complete legal names and marital status required for each ;nterested party)
<br /> Name: .1�,2�,,�, ,� �',�, i ;�-
<br /> Phone (home : ��^ y /_ a a �, Phone (work): C9/,�, a gce - g a a �.
<br /> Address: ��c�./,�' ^ o��`/� S o�2 �' D 2 � /"Ylvu .v� , /�M,� .5-�3cn C,l
<br /> Email: �'�2. �t z�. IZ r' __yy1�n� . C o �, Fax: �5 a - 4 �/- �'U� —�-
<br /> EXISTtNG LAND USE:
<br /> Number of Tax Parcels: 3
<br /> Development Size: 3��— Acres Dry Land'`"�6 4 y3� s��
<br /> �^-� �� . Acres Wet Land "`-�j �gd 5$� ��:
<br /> Acres TOTAL, all parcels
<br /> Present Use (check one) ,� Residential; Number of Units: 3
<br /> ❑ Other: (Specify)
<br /> Present Zoning District (�,,,.�? � �L,
<br /> Proposal:
<br /> ❑ Division for Tax Purposes
<br /> �1 Lot Line Rearrangement Only (no new building sifes)
<br /> � Subdivision for New Building Sites �2)
<br /> Number of Building Sites 3 Existing Units
<br /> � New Units
<br /> �' Total Units
<br /> Proposed Gross Density _ �-" Units per 3.85 Acres
<br /> Minimum Lot Size T/y�A� Square Feet Dry Buildable Land ���� �or 8cu,�IofS,
<br /> Proposed Use (check) �4 Residential
<br /> f7 Other(specify)
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