Laserfiche WebLink
Authentkign M <br />City of Orono <br />Vacation Application <br />Sfreel Address: <br />2750 Kelley Parkway <br />Orono, MN 55356 <br />Main: 952 249.4600 <br />fax. 952-2494616 <br />Mailing Address: <br />P.O. Box 65 <br />Crystal Bay. MN 55323-0056 <br />Application # <br />Date <br />Received: <br />Staff : <br />Fee 0_0, ' <br />Escrow. <br />Notes: Fees assume <br />application not part of <br />subdivision. <br />1 We request an Easement or Right of Way on/or adjacent to the following property be vacated: <br />PROPERTY INFORMATION: <br />Site Address: .3 a <br />Submittal Requirements <br />0 <br />1 <br />Completed Vacation Application <br />E3 <br />2 <br />Application fee <br />l) <br />3 <br />Escrow deposit and egreement <br />0 <br />4 <br />Survey (meeting ALL requirements) Click here for the C' 's Survey and Site Plan Requirements. <br />0 <br />5 <br />Data eriva2y form <br />13 <br />1 6 <br />Hardcover Calculation worksheets. Click here for the Ci s Hardcover Information racket. <br />0 <br />1 7 <br />Additional Information requested b Cl Stan <br />8 <br />1 Electronic co2y of all submitted materials via email, CD or flash drive. <br />PROPERTY OWNER INFORMATION: <br />Name: rVCa t <br />Phone (primary): <br />Mailing Address: 1 SO>� <br />City, State & ZIP a �; <br />Email: <br />legal names and marital status required for each interested party) <br />th✓aldpU- lyoo r,-w�e `s cc, 11146 c <br />• Certifies that the information suppled Is true and correct to the best of hislher knowledge. The applicant and owner recognize that <br />they are solely respar>sile for submitting a complete application being aware that upon failure to do so. the staff has no alternative <br />but to reject it until it Is complete or to recommend the request for denial of the request regardless of its potential merit. <br />• The Property Owner hereby acknowledges and agrees to this applicatlon and further authorizes reasonable entry onto the property <br />by City Staff consultants, agents, Commission and Council Members for purposes of investigation and verification of this request <br />• Property Owner adatowledge [hey must be present at all scheduled review meetings of the City Councal. If an ;ppplicanl andlor <br />owner is unable to attend a scheduled meeting, please make arrangements to have an authorized representative attend In place of <br />the applicantlowner and advise the City Planner assigned to y* project <br />Property Owner Signature: `.,t3Ku a gadded Date: <br />Property Owner Signature _-?„{Ap,7 ,cos s, P4r+»�e Date: <br />[ &ERE ywu� L11^44 <br />71 t.{7:5{ PM CST 17114= 7 2:115e PM CST <br />Vacation AppHcatlon - Janualy MI <br />1211412017 <br />