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`! <br /> ��� �� ����� PC ExhibitA <br /> ���� �s� ��r�i� ����ic�#Ea�r� <br /> ��a �a��: <br /> 2T60 lCQlley Parkwey �d�� F� �j <br /> Orono,MN 6535e Dab R�ed• <br /> Maln: �!92-,?4p-4B00 � ►t Ie,r� <br /> fa�c �!f2-249-461� Fee a? G'/ � `1�� . <br /> '��, ti� PA�.BoocA 88 � Escro�w*8 s �O+EJ'�' ot"� C <br /> �G Crysta�8py.MN 55323-0068 Pemllt F�8 J <br /> �'�FSHO�'' � <br /> Pbase c�mplete. Appiicant wiA be notified within 15 days as to the atatus of tl�e ap�lication. <br /> Incomplets sppikxtions wiil r,�t be plaoed on Planning Canmisaion p�er�u. <br /> gn��pc�►TipN: 2i 5 kioltQ,Y)c�r' Rd , a rulp <br /> MPLICANT/AGENT INFORMATION: <br /> App�fcarrt Name: A1 !Yl i��� i4.�l,e. Hk+�tt- �t Qot�s.r� l n� <br /> Phone(Primary): st 52 u-;y ��cj�— . <br /> A�licant Ernafi: c!s.C,am <br /> Addrgss: � /1 !vd CitY' DtzDb,a.r�1 ZiP' 5S3q I <br /> Apent Name= h�M(,t5!',,t1c� AgenYs phone number _ 2�s�q <br /> . <br /> AQerrt Emaii: (S r �1.�ev�e.'� App#icant is: ntracto Homeo�wrner (Circie One} <br /> PROPERTY OVYNER INFOR�AATION: O d�edc here it proporty o�nmer is same as appticant <br /> Name: "f 1'1 or•r� #� �-o► �1A PD <br /> Phone(Primaty): - '�"' <br /> A�ifing Addr+ess: �-1 - c� : ah o z1P� 3a <br /> E�1'dli: a0 t'A�+ t�y�� �r rv►e.�1•L�l'�M <br /> .� <br /> APPLICANT/ADENT ANDlOR OMMER: <br /> . /lproe to provide aN intormatbn requirod a requeeAed by tl�e Plenning Dept�Mrent, <br /> • AQree to psy additlonat tees(stalf tima not co�retsd i�the orighal tee payrr�enq andlor oor�uMant eo�penass incumed in <br /> revfew of 1F�s 8ppiicaUon,end <br /> • Cat't!(y that ltte infot�r�don wpplbd � ttue and comect to �s best of Fuslher la�owledpe. 1'f» y�Ilant and owner <br /> ncogr�u that fMy ars solMy e+asponsible Ior submit!!np a compist�applicatlon bNnO�wan tl�t upon failun bo <br /> do so�tlM stdt hp no aiEsrnative�t�o nej�ct Ft u�Il it h cort�pisb or bo�+�canmsitd tl�e rsqu�st tor d�nial of�w <br /> roqt�st repudNss ot itt�1 m�rlt. <br /> • lldcrrowJedpe ths Escxow Apreement ie oornpieted and sipneel. <br /> • The Owner hereby adv�ow�sdges ar�d ay�to ttas applicadon and furiher author'vss ro�son'de entry onto tl�e <br /> br cn�►s�,conwnan�s,a�c.,Cnmmiesion�d Courxsd Members ior purpoaes oi Mveati�tion�d�p��Y <br /> �� <br /> • ���� �� �eknovrledps fMy must b� pnp�nt at al! sehsdufed evvlew mNtinps of the Pl�nnina <br /> applicant endlor owr�er is unable ta atlend a scheduled rnaelb�p, plsaae mdce <br /> arrar�ments bo have an auThoriaed ropr+asentative attend in p�e af the aPPfi�Navner and advise tl�e Plamer <br /> aseipned to your pr�Ct. �Y <br /> APPlicar�iAgent Si�nature: ���b,(� �,�!. Date: ��3 ?�011� <br /> -� <br /> APplicant/Agent Si�netur+e: Date: <br /> Property Owner Si�nature� Date: <br /> Property Owner Signature; Date: <br /> l.�,au�,a�o�;�—+►�Yzors �iAY 1 8 zO1R <br /> �2 � � � �� <br /> c�nr oF oRONo <br />