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Fee:. �d <br />Case No: <br />VILLAGE OF OR,INO <br />rvStal Aqy, Minnesota <br />(Couplete in Duplicate) <br />-his form to lie used in all aYplications for special use permits and for <br />•fzonA.ng, div:diuR ur cins,)11. ating parcels of land, t+ar..ating StTaets, alle•rs <br />tud variances. <br />"I)pe of Applica'. 'n.. ✓�ti.aa �tr_ -- - -._--- _ Date <br />(*ner of 'Propert NsTe� � _— Phone�N�a7. <br />,iYtpxxL.nt (other flan awner) : Name shone No <br />Addrsss - -- - <br />Rtiat�er.sri, <br />RnRin-ee>r: Name i!{��.l11aw1.—_ Itl�3-- 'hone <br />.snd ?1an.zer : i- r.na wc`�lshl _ ?hotia No. <br />Phone No. <br />:cbdfirider: iu _ ..i�.�.filAril�/� - - -..__. _._.__.._______._ <br />.,coat on ;haw d_ -re find itT)_tPeA.Ae1_ .011 cy94010-f. <br />_ad .Crysfw.!_.RAY _,eL - f.f .. <br />,j£_ . �f-�r.�-. tire_ . ��•____._,_._.. _. _._._._._------___.___�_ _ __...__-._ . _ <br />kLegali;escripCie.t; �p _Swan Za & <br />A•ea (sq. ft.; 5et�arate Ow e,si�t <br />Date Acqu ired.��,3 �.. _�� <br />Date of list ni , ::zon of this Property /ysfr _�_.._.---..-----.__• <br />Dc you OW1 am - <br />Action Re lues%ed_YAJ.lAUA___fJ.._�!l1._�PJZ__�e_�_ _ r:1-r1_PLC.X-1�-- <br />Y -,pcct-io""-i Dent. <br />Admini,1'r.znr <br />village C,)uncxl: <br />Village EiRinOer <br />`tillage Attorney: <br />iartature ur Applicant <br />RECORD OF ACTION MEN <br />[' :a Atticn <br />( <br />wr 2 <br />