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<br /> Streef Address: Application# rj(�-• - �'
<br /> � (�� 2750 Kelley Parkway �Date Received: �_/p-/ -afp
<br /> Orono, MN 55356 Amount Paid:
<br /> . �_� � Staff: �'2��Cc�n 77irr1.m�
<br /> ,'�� Main: 952-249-4600
<br /> ,� � ,�.,�- Fee: $600
<br /> ,� ,,,h� ti fax: 952-249-4616 RenewaL• $300
<br /> ��� �� MailingAddress: � After-the-fact: $1,200 Double Fee
<br /> �gEs�io'�'� 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 /> app�ication. Incomplete applications will not be placed on Planning Commission Agendas.
<br /> PROPERTY INFORMAT(ON: . ��
<br /> Site Address: zOC� Noll�►�dQr �oAC�
<br /> Property Identification Number (PIN): . �
<br /> (Attach legal description to application�if�,ot included on the survey.) .
<br /> Date Property Acquired (month/year):S N«"�q�� ❑ Yes, I own the adjacent parcels.
<br /> Present use of property: I�'Residential � Other � �
<br /> Zoning District: �� - ��j
<br /> APPLICANT INFORMATfON: (Complete legal names and marital status required for each interested party)
<br /> IVame: Jo�l n �o�l A�1�,2� � �
<br /> Phone home . '
<br /> � � ) Col? - Z�l�_�l�9 Phone (work):
<br /> '�' '�ddress;. " ZGO . :h/a//�hr/e.r �?c��xl 1,���,;.�� ' �� ,55391 �
<br /> EmaiL• � • � Fax: �
<br /> OWNER INFORM/ATION: (Complefe legal names and marital status required for each interested party) `
<br /> Name: S �m� .
<br /> Phone (home): Phone (work): �
<br /> Address: -
<br /> Email: � �� Fax:
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<br /> DESCRIPTION OF REQUEST: _ Estimated Project Cost: $ _
<br /> Describe the request in detail attach additional shee�.s��h�cessary): � <
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