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/O <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />REQUIRED SUBMITTALS <br />\ ____Completed Application Form. <br />“ed VTp?.^”ot!.«s Usi of o^.,,=rs withm 350’, labels and plat ^p (you <br />^us" obiain to list, labels and map from Hennepm County Department of <br />Pi nance A-603. Government Center, 348-3271). . . f <br />St. or s;..ey (sigoed by a licensed surveyor) - refer to handout for survey <br />'n°"HT.!ai dascrintion to application if nor included on required siuvcy <br />To^cS S ptoposed contours) if land alterations mvoWe <br />S’ti; trllSude n.arit.1 status) of all persons with an interest in <br />■ to oS TOs vtould include name(s) of appUeantCs) tf not current owner(s). <br />Constriction plan, if applicable (sec staff for requirements). <br />• AnrSfdeXt to this application, please attach a separate list of any other <br />' persons you wish notified of this application. <br />TORS^M^rTEa (Starr will require to scale drawings of all dt tments, plans, etc. to <br />submitted.) <br />I^^totionTnfJrTpS <br />Certification by Clerical Dcp.rtn.cnt that Und Use Applicarioo is complete. <br />Initials of Clerical Slaff.^,---------■ ■■ —-------- ^ <br />APPUCANT'S signature reouired or requested by the 7-orimg <br />The applicant hereby agrees P™",j „o, covered by original fee payment) <br />Administrator, agtocs to pay additional s«fr t <br />andfor unusual bcL of histor knowledge.infonnation supplied ts IrutT^d coiTw . <br />Date ll/liill___ <br />Applicant's sigitaturc (f\AyCC'^ <br />Tom Dillon, Orono Development, LLC <br />OWNER'S SIGNATURE aDoUcaiion and furtltcr aulhcuidica <br />The owner hereby by City's^ff consultant, agents, commissicn men-hers.rctr./rr;r^;i:i;nS42- - —- •' "• -r <br />-'ll -■ ......... <br />Date I “tr <br />Aden. SatUh Company Med-S. <br />Applicei met h.« .11 wba'itl.U ^ b« P"""'/; <br />PUnnlnt Commission Commission .od Cooocil. If on oppbc.o. is <br />all achodiilcd v^vicbY ^ .......... Buthofi/cd aRcnt otiend In your plncc and