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. . EXHIBIT
<br /> � ��ty Of ��'�YI�D A .
<br /> . Vari�r�ce .��p�i�at�c�ri .
<br /> Street Address: Application# (,"1'�•- ,�';� G��.�.`
<br /> � ��� 2750 Kelley Parkway •Date Received; -
<br /> Orono, MN 55356 Amount Paid; "'(�,(_,-Y=)
<br /> � � � � . Sfaff : �.�'
<br /> . ���,, c � Main: 952-249-4600 Fee: $600 �
<br /> � ,� �� �' ��:.y �+ fax: 952-249-4616 � Renewal: $300
<br /> '�',� ��� �, '���'� �titi Maifing Address: � � After-the-fact; $1,200 Double Fee •
<br /> � L`��'Es�xo�'� 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 /> �application: Incomplete app(ications will not be placed on Planning Commission Agendas.
<br /> �.: ,PROPERTY INFORIV�A 10� 9 �. � .
<br /> . Site Address: � � � "��— � �� ` _ ���vr`�V��.'j � '}e SS •�rJ C'��
<br /> ;�Property Identification Number.(PIN): � � 1 ]�l�Z3',3�- Ec��,�' � �
<br /> �:���:�..(Attach legal description to application if no included on the survey.) .
<br /> ;�:�te,Property Acquired�(m�onth/year}: � t�'(cT ❑ Yes, I own the adjacent parcels. .
<br /> sent use of property: �(Residential �0 Other � �
<br /> ,. .
<br /> . . ., .
<br /> �oning District- _. .. � ._.., � L, _ . ._ _ _ . . ; .:: . .:..
<br /> APPLICANT INFORMATION: (Complete legal names and marital status required for each interestecl party) � '
<br /> .� Name: ��' ��,1� �� C;d '��� � �7�� C� � � �
<br /> � Phone (home): U� i �(��'1�� - C'�c3 S� Phone (work); �����-����j -�3a� .
<br /> . Address: , �' C; - � " jr/'? � �
<br /> Email: ��c�l���vt�C,���::. (�� no .��i � . C�t� Fax: l�S' - (c X� �' S i5� . .�
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<br /> ,�'OWNER INFORMAT6�N: (Complete legal nam�es �nd marital status requi�ed for each interested party) � � � , .
<br /> , , -- �-
<br /> . . Name: �C-/U,�� �- �� � � � :
<br /> � . � Phone (liome): �l�--��Sr-y `� � �" Phone (work): f- �'G7t��- C��7�°- �>>-� �
<br /> � LU •11�"��../�� �l�C /�'`G'trr S�l�l� �'U S , (,� / — ' j � �"t,�.D ' � '
<br /> Address: f����
<br /> . Email: � h'l 1�13(�NI�j't-� �. ��G�,. GCI�I Fax: 1=SE �- �-�E,°- �-�c`!.2
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<br /> � ���SCRIPT10i�,�� PEQUE��:. � Estimated Project �ost: � �, �-��1 ���,�,:�
<br /> Describe the request in c�etail (attach additional sheets if necessary); ° ����� t,�'o1�� rc�
<br /> � f�i i��� ��. ,����;�c c� n��1 ,1f�����s�� ��,2t����;�,,.�f �s� �� ��;F ��t�
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