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� ' � PC Exhibit A <br /> � City of Orono <br /> '± ��- �� ` � � � ��ubdivision A � lication <br /> �.��: ��.<<l _ :..;., p p <br /> ;t . ; ;� ; <br /> . . ... <br /> Street Address: Application# 67 ^. Z d <br /> �Q� 2750 Kelley Parkway Date Received: �� /o"] <br /> Orono, MN 55356 Amount Paid: � <br /> � � Staff: <br /> ° Main: 952-249-4600 Fee: <br /> a � +� ��,•: a� fax: 952-249-4616 . Renewal: <br /> �'�,c, • �ti`� Mailing Address: <br /> l � P.O. Box 66 <br /> `�k'ESBO�' Crystal Bay, MN 55323-0066 <br /> This appfication form must be completed in full. � <br /> PROPERTY INFORMATIO : _ <br /> Site Address: �`.> � � � GS��I�C;`7 ��-�'� � �I/.��1� � (�► <br /> Property Identification N mber(PIN): �S - � �- �3 � - " ��0 (>OC7 <br /> (Attach legal description to application if not included on the survey.) ' <br /> Date Property Acquired (montl�/year): ❑ Abstract or O Torrens, please check one <br /> Present use of property: L�Residential ❑ Other <br /> Zoning District: <br /> APPLICANT INFORMATyION: (Complete legal names and marital status required for each interested party) <br /> Name: ��1�l-� /�v?�1 G <br /> Phone (home): � � L u� • Phone (work): 5 2 - _.(tif� <br /> Address: L �l/ CJ n �- <br /> Email: � �- Fax: -�, � <br /> OWNER INFORMATION: (Complete legal names and marital status required for each interested party) <br /> Name: � <br /> Phone (home): Phone (work): <br /> Address: • <br /> Email: Fax: <br /> EXISTING LAND USE: � � <br /> Number of Tax Parcels: � <br /> Development Size: Acres Dry Land <br /> Acres Wet Land <br /> Acres TOTAL, all parcels <br /> Present Use (check one) ❑ Residential; Number of Units: - <br /> � Other: (Specify) <br /> Present Zoning District ` <br /> Proposal: . <br /> ❑—/ Division for Tax Purposes . � <br /> C�' Lot Line Rearrangement Only (no new building sites) <br /> ❑ Subdivision for New Building Sites <br /> Number of Building Sites Existing Units <br /> � New Units <br /> � Total Units <br /> Proposed Gross Density Units per Acres <br /> Minimum Lot Size Square Feet Dry Buildable Land <br /> Proposed Use (check) ❑ Residential • <br /> ❑ Other (specify) <br /> - 10 - <br />