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i�� o� �o�� <br /> a�°��n�� ��I���t�o� <br /> Street Address: Application# <br /> ��� 2750 Kelley Parl<way Date Received: <br /> Orono, MN 5535G i4mount Paid: <br /> � .;. � Staff: <br /> v1,- <br /> � Main: 952-249-4600 Fee: $600 <br /> �. �F <br /> �a �'�2� a� fax: 952-249-4616 Renewal: $300 <br /> �'.�,� ����'�- ��`5' Mailing Address: After-the-fact: $1,200 Double Fee <br /> � � -i�r���� P.O. Box 66 <br /> ��sH� Crystal Bay, MN 55323-0066 <br /> Tl�is application form must be completed in full. Applicant will be notified within 15 days as to the status of the <br /> application. Incomplete applications vvill noi be placed on Planning Commission Agendas. <br /> PROPERTY I{�Ft�RMA�'IOM: <br /> Site Address: <br /> Property Identification Number (PIN): <br /> (Attach legal description to application if not included on the survey.) <br /> Date Pro�erty Acquired (month/year): ❑ Yes, I own the adjacent parcels. <br /> Present use of property: ❑ Residential ❑ Other <br /> Zoning District: � - <br /> APPLICAtVT I�IFORMATIO(�!: (Complete legal names and marital status required for each interested party) <br /> Name: <br /> Phone (home): Phone (work): <br /> Address: <br /> EmaiL• Fax: <br /> Ol�UNEdi IfVF RMATION: (Com�lete legal names and marital status required for each interested party) <br /> Name: �� ,.�r.. �' 1�li�C..-�C i : <br /> Phone (home): S� � �—"71 Phone (work): <br /> Address: I � 4 ;/_I:�.�� ' tw� a� . /�?�prr-}� j�>�-�7'S' �t- ��J 7� <br /> Email: Fax: <br /> DESCRIPTIOR! OF REQUE�T: Estimated Project Cost: $ <br /> Describe the requ�st in detail (attach additional sheets if necessary): <br />