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■ � <br /> • . �1 ty� �f �t"c�r�c� �`- <br /> �V�rian�� �pa�lic�ti�r� <br /> StreetAddress; Application# (xe��l�-GU <br /> �(� h� 2750 Kelley Parkway Date Received: �J-�� -�j C� <br /> '�V � Orono, MN 55356 Amount I'aid: (o CU. v� <br /> � � �Staff: ),_/t Ice <br /> ��� � Main: 952-249-4600 _ Fee: $600 <br /> � , ,��. �+ fax: 952-249-4616 Renewal: $300 <br /> � � Gw`� Mailing Address: After-the-fact: $'1,200 boubie Fee <br /> �`�EsHO�`'� P.O, Box 66 <br /> Crystal 6ay, 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. Incomplete applications will not be plac�d on f�lanning Commission /�genda�. <br /> PROPERTY ItJFORIVIATtON; <br /> Site Address: I 3�7 �� �0�� <br /> Property Identification Number (PIN): O? l� �,.'3 33 �l 1. � <br /> (Attach legal description to application if not included on the survey.) <br /> Date Property Acquired (month/year): -2� ❑ Yes, I own the adjacent parcels. � <br /> Present use of property: � Residential CI Qther � <br /> Zoning District: <br /> � APPLICANT INFORIVrATION: (Complete legal names and rraarital status required for each interested party) <br /> Name: �a � <br /> Phone (home): �3 �,oe Phone (work): �'/�.- �'v _ ��� <br /> Address: t�,,. � ,M,� - <br /> EmaiL• Fax: g,��. ' �/ � 3-��� <br /> OWNEIZ INFORMATION: (Complete legal n�mes and marital status required for each interested party) <br /> Name: � r� �,,r ,4 .e <br /> Phone (home): 7-,5- Pho e (work): �_�� q <br /> Address: <br /> Email: S o Fax: <br /> DESCRIPTIOfV OF REQUEST: Estimated Project Cost: � S� Q�Q <br /> Describe the:request in detail (attach additional sheets if necessary): <br /> ::�� . . <br /> ':�k�`' .G►;�{-- G�v�nn !/�'1 <br /> lr��K ' -�c� �ca �afi C�- �C' �,�1( �p� f,���, <br /> . ,�,. <br /> �� � ti�'��wYp •%�s�'"�a�•,l.- -`���� r,• <br /> /'� �� r` �. 'x:� <br /> �7 h �� ° ' r� d : � i; •�, �; <br /> r, �, ;. <br /> . . . ��� ��' �, 4-; � i • . <br /> rL u.f.2 2 '?� <br /> � ��. r ,; �;�1,� <br /> �t" ('; ��:... r' � ` ... ,:;��'� 'Y�-.;+°'. <br />