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Fee: <br />Case No: <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota <br />(Complete in Duplicate) <br />This form to be used in z applications for special use permits and <br />for rezoning, dividing or nsolidating parcels of land, vacating <br />streets, alleys and varian,es. <br />Type of Application ��L a44 Date_L <br />Owner of Property: Namer�g!' Phone NO. 7y/7 <br />p/� n <br />Address: Name 1 c c� <br />Applicant (other than owner �/ No. <br />P ) <br />Address <br />Relationship to Owner <br />Engineer: Namc <br />Land Planner: Name <br />Phone No. <br />Phone No. <br />Subdivider: Name Phone No. <br />Location (How Ldo we find it?) <br />Legal Description: 0b f /�/ �- g yre/ -196 <br />—T/ ' Single Owjiers n, 1--- <br />Date Acquired Area (sq. ft.) __Separate :_1wner.ship <br />Date of last Division of this Property_ <br />Do you own any adjoining property? <br />Action Requested_ GiL-r-1 4 11 e df-& e. 6/ <br />Signature of Appl' nt <br />RECORD Oc ACTION TAKEN <br />Date Action <br />Inspection Dept. CFifr G / c <br />Administrator: <br />Village Council: <br />Village Engineer: <br />Village Attorney: <br />Planning Commission: <br />Village Council: <br />Permit Issued: Date <br />