|
���y fi ����
<br /> � � ��a�c� ������o
<br /> Streef Address: Application# j(�-.�� ��
<br /> ��� 2750 Kelley Paricway Date Received: �- ���
<br /> Orono, MN 55356 Amount Paid: �.�ID
<br /> Staff: `�11�e�(,t�v„c�
<br /> � A��'� � Main: 952-249-4600 Fee: $600
<br /> ,� ��' '��. � fax: 952-249-461G Renewal: $250
<br /> �',� . �'�� Gti`�' Mailing Address: After-the-fact: $1,200 Double Fee
<br /> Z.�k,�sHOg,� P.O. Box 66
<br /> Crystal Bay, MN 55323-0066
<br /> This application form must be completed in full. Applicant will be notified within 15 days as to the status of the
<br /> application. s��omplefe applic��ions wi11 r�ot �e pB�ced on �lat��ing Co�a�ession d4gend�s.
<br /> PROPE�2`TY IhIFOR ,4T'IOIV:
<br /> Site Address: � C- �i �� � �' .� �rJr�O �J �`'
<br /> Property ldentification umber(Pl ):
<br /> (Attach legal description to application if n included on the survey.)
<br /> Date Property Acquired (month/year): f� , �❑ Yes, I own the adjacent parcels.
<br /> Present use of property: I�(Residential Other
<br /> Zoning District: �
<br /> �4PPLIC�4iV`T I�VFORIIliATlO : (Complete legal names and marital status required for each interested party)
<br /> Name: �e.� o� .�,r
<br /> Phone (home): -r._ /� Phone (work): ,.5�-n�
<br /> Address: � �) �1. City: fo n.� Zip� 5 53��/
<br /> Email: ;a��� /�/l�Ite l��n e�����t;/..�"n�,., Fax:
<br /> U lti�'S Ci�G2 ,�%
<br /> OVi�N�R INF06aMATION: (Complete legal names and marital status required for each interested party)
<br /> Name: �)� � � �ilSl�c�l4�;, , Y1�� ✓1'��=��;��i
<br /> Phone (home : (/�-,j��i r/ � 3 j-/� Phone (work): S�-
<br /> Address: , �,�'�i., ��� 1���r �i��< G�c�.- _ City: ,O!"a n� Zip: 5�S.3��
<br /> Email: �� 'F_,�,zFk��ce�.s��G2 l��r�►�l/���,r� Fax:
<br /> p�����py0�� p� ��(�����'; Estimated Project Cost: $
<br /> De^ sc_ribe the�request in detail (attach additional sheets if necessary):
<br /> �ei,� ���L.6,i1, G� xi S�'�� � Gt n.t� �'l��(L I'1.��„i e`� � C4% ���
<br /> � � ���
<br /> /�, - � ' � � 1� i �, ✓►'!`n ',�� r;�r�`l,�ct' � ���r r,� 1 tv�1
<br /> G�� vr•� ��'i.5��,1,/ �'�t S;tilc��
<br /> �°'+-A'',. y:=+t,�'�y!
<br /> '
<br /> �� •�:.�' /,: .t•�k
<br /> f��rtsr :r.;f•� ( i��� ��� .. ,
<br /> �' �[';%� t:�;•:.-��:<�'; ' i
<br /> .,
<br /> •.:'v%•:.::�,.,..,,
<br /> r,•� �ry
<br /> �� �.) t� �': . �� .i
<br /> w,r �•� a� 7 :.��` V�`::; _.. ..
<br /> y£:'?'v �'�sf ���„3�h �J� �';'.. .;1„' � �:SC:�v+�'��
<br /> �'� F:� J.`;1 �:. J �F:�':.�.c
<br /> � / .! � [r:s'�.a'x.`'
<br /> ���n��ii• .
<br />
|