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� <br /> CttJ/ ofi UrotlO <br /> - �u�bd �visior� Application <br /> Street Address; Application # �� �- �% '� � <br /> � �� 2750 Kelley Parkway Date Received: �,•- ?'? ���.j <br /> Orono, MN 55356 Amount Paid: ;� �;�j GJ�. <br /> � ��e� � Staff: /rl-t.'r"l'. <br /> ° ��,�, Main: 952-249-4600 Fee; �;�jt�' : <br /> �>�., °f� - <br /> � �� ',��'`r`�'~'�y F fax; 952-249-4616 Renewal: •— <br /> �,c, . ��y, �w Mailing Address; <br /> �9kESH��� P,O. Box 66 <br /> Crystal Bay, MN 55323-0066 <br /> This application form must be cornp(efed in fulf. <br /> PROPERTY INFORMATION: ° <br /> Site Address: c-�,e,� �e,�., �- l.e �.�1 I �b N � �`1�..� `��t ' <br /> Property Identification Number (PIN): �, � -��,�� � Q ��� c��$- `��m �,�� � , <br /> (Attach legal description to application if no�ncluded on the survey,) <br /> Date Property Acquired (month/year): Gd„ ��,� �Abstract or L�,'Torrens, please check one <br /> Present use of property: '�Residential � Other �,I��r�.�, <br /> Zaning District; <br /> APPLICANT INFORMATION: (Complete legal names and marital status required for each interested party) <br /> Name: �o4n��.����te*e�.��- � °�'�rc _ � o ��e.`.�. ���� <br /> Phone (tiam�e):cs�. 1 S�. ��7 _ �.��v Phone (work); t�. ��( ��{�' <br /> Address: 0$�!�( fx���.z�� �,�.u�.� Qo � B� �•o� G���c �^• ��,3 <br /> Email: ��r�,� � �o�.��..e c��.cecQ�e�►�a. •�e� Fax: ��j�..- � � �BeC <br /> OWNER INFORMATION: (Complete legal names and marital status required for each interested party) <br /> Name: �c��dA '�fes��� $tc��.a. C_�eo.r�c� G�� ��� �����e�-� � <br /> Phone (home): .. ' �,o� Phone (work); _v <br /> Address: �Ca.c-� e�0,�e �- � �a�t � �.. �� �-�R� M�ao �� �, <br /> Email: �Q � �����, t'e�� Fax: <br /> EXISTING LAND USE: �.� <br /> Number of Tax Parcels: � � <br /> - t���..�� o 0 <br /> Development Size: �-� > ";' �.'" Acres Dry Land �--6'f� �^� �`�'��' ��������' °�° <br /> _ - Acres Wet Land 6�� �, �6����� ��� <br /> ;� . �i-�.; Acres TOTAL, all parcels ��,�� �� Q�� �� e �-�`��"� <br /> Present Use (check one) � Residential; Number of Units: fl <br /> � Other: (Specify) �(�� �� L� <br /> Present Zoning District "� �,��, � ,�„ �,�Q�9.�. <br /> 6�s��posa�: . <br /> ❑ Division for Tax Purposes <br /> ❑ Lot Line Rearrangement Only (no new building sites} <br /> � Subdivision for New Building Sites <br /> Number of Building Sites � Existing l�nits �• �����-� � �-�� � <br /> � New Units <br /> d� Total Units <br /> Proposed Gross Density � �� �- Units per Acres <br /> Minimum Lot Size ea.�� � Square Feet Dry Buildable Land <br /> Proposed Use (check) ��Residential <br /> Other, s ecif �a� ° ° <br /> 'q�- (. P Y) _��a�tS��, g �'�F�•� a� ��� t��'�.r—_, <br /> � • ��� - 10 - �' <br />