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[� � ' �� o� ron <br /> a�sanc g�l��atio . <br /> � Street Address: A lication# <br /> Pp <br /> ��� 2750 Kelley Parkway Date Received: <br /> Orono, MN 55356 Amount Paid: <br /> . � � � Sfaff: <br /> ��`� Main: 952-249-4600 Fee: $600 <br /> � �- ��':«,�"`,��. s+ fax: 952-249-4616 • <br /> Renewal: $300 <br /> �• �� � �1T`".g��'~� P.O./ox 66ress: After-the-fact: $1,200 Douhle Fee <br /> ����sH� Crystal Bay, MN 55323-0066 <br /> l_� <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 no# be placed on Planning Comrnission Agendas. <br /> PFZOPERT'Y INFOEtiUTATION: <br /> � Site Address: <br /> ' Property Identification Number (PIN): <br /> (Attach legal description to application if not included on the survey.) . <br /> Date Property Acquired (month/year): 0 Yes, I own the adjacent parcels. <br /> ��' Present use of property: ❑ Residential ❑ Other <br /> _� Zoning District: <br /> "� APP�.ICAiVT IPl�rORMATION: Com lete le al names and marital status re uired for each interested art <br /> � p J q P Y) <br /> � Name: <br /> �l Phone (home): Phone (work): <br /> Address: <br /> Email: Fax: <br /> `'' OWNER IiVF F�MATION: Com lete le al names and marital status re uired for e c ' e s d <br /> ( g q a h mt re te party) <br /> ., Name: _ �..�.�. � �f�-� . <br /> [� Phone (home): S' � �—"7� Phone (work): <br /> Address: C � 0 ' ,4 �� ` �o����. /�'!��-i�� �g>���r5' �� ��11� <br /> . EmaiL• Fax: <br /> �, E <br /> D �CRIPTI�DPJ OF REQUEST: Esfimated Pro�ect Cost: $ <br /> Describe the request in detail (attach additional sheets if necessary): <br /> L_., . <br /> i_� <br /> l�a . <br /> .i ;,... $��.. �; <br /> _.. s�+ '' ;' � '�": .,i.,< <br /> y•, , f �. :Y-'.,<, 'y •. <br /> ( . f � , c�.Y.,:. <br /> �_. �� • [. ��. f. 4 . <br /> f <br /> �t ,�' <br /> t _i . <br />