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City of Orono EXHIBIT A <br />Subdivision Application <br />Street Address: <br />2750 Kelley Parkway <br />Orono, MN 55356 <br />Main: 952-249-4600 <br />fax: 952-249-4616 <br />Mailing Address: <br />P.O. Box 66 <br />Crystal Bay, MN 55323-0066 <br />Application# Dl/-3[J{)~ <br />Date Received: 3--z.._s-o_ <br />Amount Paid: 3$ 0. Q{) <br />Staff : Ja11 f Ce <br />Fee: 3SO.OO <br />Renewal: <br />This application form must be completed in full. <br />PROPERTY INFORMATION: <br />Site Address: ·~~~ ~ · <br />Property Identification Number (PIN): --=o_g=:J_-_,,_,/__,_· _,_Z_.:;c3_-_....,.__ _ __;__,___ __________ _ <br />(Attach legal description to application if not included on the survey.) <br />Date Property Acquired (mont~/year): ----~Abstractor □ Torrens, please check one <br />Present use of property: £(Residential □ Other <br />Zoning District: L(<.. -/ i3 <br />APPLICANT INFORMATION: (Complete legal names and marital status required for each interested party) <br />Name: cl-1=.7..!;;? !11-1-1 e ~ /{._ 73E~ 6\.-.= -,.J <br />Phone (home): 9s.-z. ~"ft?;-'-/bi~ Phone (work): ~·z.--9,.... 0 z,3 <br />Address: "3 c Z... w. f'-A:f'l,~ Sr,, ('c?L@:id£ . ';,/. . S:S::: ? "2--2. <br />Email: _________________ Fax: ':952-~2 z..z._f0 <br />OWNER INFORMATION: (Complete legal names and marital status required for each interested party) <br />Name: /?i<:._f·fA-rL1? A. §Or-20( <br />Phone (home): -------~----Phone (work): <br />Address: /-S3S"' )?f;Ol{AI j)O/Af1 (2./J, <br />Email: J Fax: -------------------EXISTING LAND USE: <br />Number of Tax Parcels: <br />Development Size: <br />I <br />_ _._4_;.9~3-Acres Dry Land <br />O. f_i Acres Wet Land <br />5', Acres TOTAL, all parcels ---"''--'-+--- <br />Present Use (check one) <br />Present Zoning District <br />Proposal: <br />~ Residential; Number of Units: <br />Other: (Specify) <br />L-72--!E <br />□ Division for Tax Purposes <br />□ Lot Line Rearrangement Only (no new building sites) <br />i'( Subdivision for New Building Sites <br />Number of Building Sites / Existing Units <br />Proposed Gross Density <br />Minimum Lot Size <br />Proposed Use (check) <br />Z. New Units <br />3 Total Units <br />-~-""'---Units per S: f Acres <br />:3, 5""tf::;c) Square Feet Dry Buildable Land <br />Residential <br />□ Other (specify) <br />-10 -