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Cit of C�rono ����`��D <br /> y �u� 2 0 2o�s <br /> Conditional Us� Permit Applicati('�n <br /> Ll`�YbF ORONO <br /> Streef Address: / _ ��� <br /> �A O/,lO 2750 Kelley Parkway Application# _ <br /> y- ` r Orono, MN 55356 Date ReCeived: �j�� PC ExhibitA <br /> �.� � <br /> Z Main: 952-249-46pp S��• �� <br /> fax: 852-249-4616 FBe: � <br /> +'l Malling Address: � <br /> � � P.O.Box 66 ESCroW#8�$ <br /> � G� Crystal Bay,MfV 55323-0066 PBRT1i�Fee <br /> �'�kFs x oa`` <br /> Notes_ <br /> Please compiete. Applicant wili be nofified within 15 days as to the status of the application. <br /> Incomplete apptications will not be placed vn Planning Commisston Agendas. <br /> SiTE LOCAT{ON: c-. ,5 �`/'� -� ;��,o� �o� <br /> APPI.ICANT!AGENT INFORMATfON: �� —� <br /> Applicant Name: ll <br /> Phone(Primary): —__ ..>,_���.�--��.�s , .� � C..L L �j`f /Q4. c�.�c�� <br /> Applicant EmaiL �,�.,�� �,-�-�4�{,�� ' <br /> Address: �' ' Cit : � <br /> Agent Name: - �Z�P� <br /> '.�L AgenYs phone number - ' � ZIG - <br /> Agent Email: _ fi�����, _ pppficant is: Contractor Ftorneowner (Circle One} <br /> �r�=-�,a�i- <br /> PROPERTY OWNER IN�ORMAT�N: ❑check here if property owner is same as ppli nt <br /> Name: -- �__ �'`l;"'� �-�-�.n f_i.ti __����c�� �� <br /> --— �,� <br /> Phone(Primary): ;,�� � 1� �Z / - <br /> Mailing Address: L/v �) (JQ �� �j i F� � , Cit :�(� 7�p,�-�Q� - <br /> Email. �`�;� (� . -_. s-��. ` _ <br /> �:, �.r..�, ���,-�_�s�� . -- <br /> APPLICANTlAGENT AND/OR OWNER: <br /> • Agree to provide all information required or reguested by the Planning Department, <br /> • Agree to pay additional fees{staff time not covered In the original fee payment)and/or consultant expenses incurred in <br /> review of this appliqtion,and <br /> • Certify that the infarmation suppliecf is true and correct to the best of hisRier knowlecige. The appllca�t and owner <br /> recognize that they are soleiy responsible for submitting a complete applicatlon being aware that upon fallur�e to <br /> do so,the staff has no altemattve but to reject it untll tt is complete or to recommend the request for denia!of the <br /> request regardless of Its potentlal 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,consuftants,egents, Commission and Council Members for purposes of investlgation and verification of this <br /> request. <br /> • Owner antf/or Applicant acknowledge they must be present at atl scheduled review meetings of the Planning <br /> Commission and Counall. If an applicant and/or owner is unable to attend a schedufed meeting, pfease make <br /> arrangements to have an authorjyPd.representafiie attend in place of the applicanUowner and advise the City Planner <br /> assigned to your project. � <br /> r <br /> Applicant/Agent Signatur�. �� � , ���� <br /> !� _"Date: --�-=�-2 a/� <br /> AppficanUAgent Signature: "" �"� Dat� � <br /> �:.- _ � � s <br /> Property Owner Si�nature ` � �' Date: � - <br /> Property OvWier Signature. � �'�`� c�'� <br /> Date: <br /> CUP Application-Jenuary 2016 <br /> Pa�e 2 <br /> # 385G <br />