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City of Orono A <br />Subdivision Application <br />Street Address: <br />2750 Kelley Parkv iy <br />Orono, MN 55356 <br />Main: 952-249-4600 <br />fax: 952-249-4616 Renewal: <br />Mailing Address: <br />P.O. Box 66 <br />Crystal Bay. MN 55323-0066 <br />This application form must be completed in full. <br />Application # 0^ - <br />Date Received L/IZ^IQH’ <br />Amount Paid. <br />Staff: <br />Fee; <br />^no on <br />«■’ C'- HTS <br />PROPERTY INFORMATION: iv > J <br />Site Address: V'TjtQ HiSO \!L-h.__________________________ <br />Property Identification Number (PIN); e'7 - I n • -oojn QO>0 oo 11 &o < <br />(Attach legal description to application if not included on the survey.) <br />Date Property Acquired (month/year): ________fS' Abstract or □ Torrens, please check one <br />Present use of property: M Residential □ Other______________________________________ <br />Zoning District; ______________________ <br />NFORWIATION: (Complete |«al.names and marital status required fer each interested party) <br />^/-d t/e>^ P Pc<lwii>r~______ft:;7h /H«.>rr>ecl <br />APPLICANT INFORMA <br />Name; ._____ <br />Phone (home); <br />Address; *-/ T ciP ^ 7^0 T* r <br />Email: ____73. ^ <br />. [jl _Z. n <br />Fax; <br />OWNER INFORMATION: (Complete legal names and pantal status required for each interested party) <br />Name: if-€“ HrKfjoIrt ijj'/rcxly tYp.r-_______0 c~tt-i f'ur-'i/is AP(■*>’/'>'li' <br />Phone (home); <br />Address; ^hr/o <br />Email; <br />H'O. Plyjne (work); <br />Iricuf Lt-n <br />Fax: <br />EXISTING LAND USE: <br />Number of Tax Parcels: <br />Development Size: <br />t|- <br />3 .C3S Acres Dry Land <br />p_>_0 7_Acres Wet Land <br />3. /c>S Acres TOTAL, all parcels <br />Present Use (check one) <br />Present Zoning District <br />.0 Residential; Number of Units: <br />□ Other: (Specify) <br />ZA-J6 <br />Proposal: <br />□ Division for Tax Purposes <br />S Lot Line Rearrangement Only (no new building sites) <br />□ Subdivision for New Building Sites <br />Number of Building Site <br />Proposed Gross Density <br />Minimum Lot Size <br />Proposed Use (check) <br />S <br />Existing Units <br />New Units <br />Total Units <br />Units per Acres <br />Square Feet Dry Buildable Land <br />Residential <br />□ Other (specify) __________________ <br />-10-Pi I; i.7 // 'A /; '^4*7 fv