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' � PC Exhibit A <br /> City of Orono <br /> Ordinance Amendment / Zone Change Ap licatiot� <br /> w v u ���C'. <br /> StreetAddress: Application# Fj - g y 7 <br /> �O/,T 2750 Kelley Parliway � <br /> '` VO Orono,MN 55356 Date Received: •- - b <br /> Maln: 952-249-4600 Staff: �f y(�Q/{- <br /> fax: 952-249-4616 Fee: <br /> ,� Ma!ling Address: EsCfow#&$ <br /> `� � P.O.Box 66 <br /> � G~ Crystal Bay,MN 55323-0066 PeR11it Fee <br /> r�kFSH��� Notes: <br /> Please compiete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applications wiU not be placed on Pianning Commission Agendas. <br /> SITE LOCATION: �su� �3 Jf' �Z S�S' ��,{��A� t,l�UU� ��tf�,�j ��p,�,��, �� <br /> APPLICANT/AGENT INFORMATION: <br /> Name: ���k� ��vJ V✓��lN-- - ���.S�.,.11 W�Q C.s,' 7 �..�� <br /> Phone(Primary): �el �, d ���. ��� <br /> Email Address: ��,�i j„� ,u � ���� <br /> Mailing Address: � <br /> �J '\? , City: �(,(�s� Z1P: �` <br /> PROPERTY OWNER INFORMATION: ❑check ere if property owner is same as applicant <br /> � Name: , r ,e n ,,.� <br /> Phone(Primary): ,_ S-���, <br /> Email Address: �Q�v c_ � ��,,�„� <br /> Mailing Address: ���� ��y, �� C (�� ,��1 l (' City: C �, �S ,�4 ZIP' S"S 3 /� <br /> APPLICANTIAGENT AND/OR OWNER: <br /> • Agree to provide all information required or requested by the Planning Department, <br /> • Agree to pay additionai fees (staff time not covered in the original fee payment) and/or consultant expenses incurred In <br /> review of this application,and <br /> • Certify that the information supplied is true and correct to the best of his/her knowledge. The applicanUagent and property <br /> owner recognize that they are solely responsibie for submitting a complete application being aware that upon <br /> . failure to do so, the staff has no alternattve but to reject it untll it ts complete or to recommend the request for <br /> denlal of the request regardless of its potential merit. <br /> • Acknowledge the Escrow Agreement is completed and signed. <br /> • The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property <br /> by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification of this <br /> req uest. <br /> • Owner and/or applicanUagent acknowledge they must be present at all scheduled revlew meetings of the Planning <br /> Commission and Council. If an applicant and/or o ' unable to attend a scheduled meeting, piease make <br /> arrangements to have an authorized represen#ativ end in p ce of the applicant/owner and advise the City Planner <br /> assigned to your project. <br /> Applicant/Agent Signatur : .•{.+., Date: _ ��- �—.�t$ �., <br /> Property Owner Signature: Date: ��7 / /� <br /> Property Owner Signature: / Date: <br /> Orc/inance Amendmenf/Zone Change Appllcatlon- <br /> January 2016 _ <br /> Page 2 <br />