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PC ExhibitA <br /> C��cc��� ���y City of �rono <br /> . . <br /> 275�0 Kell�P2rkway p►PP�iC9tion# � <br /> ����o Orono�MN 55356 Date Received: — � <br /> � �a MaEn: 952-249-4600 ��: 1� <br /> fa�c 952-2,49�4616 Fee: Q <br /> .� AIa!!!ng Addrssa: <br /> 'y�, � ,�� P.O.Box 86 ESCroW#8 S 7 <br /> G Crystal Bay,MN 55323-o06B Permit Fee <br /> �qxES N OR�` Af�es: <br /> Please complete. Applicant wifl be netified within 15 days as to the status of the application. <br /> Incomplete applicattona will not be placed on Planning Commission Agendas. <br /> SITE LOCATION: ��0 3 5 rc LL�`� Pi��,J O/�o /Vj/\J <br /> APPLICANT/AGENT INfORMA'TION: '33~ �� �� �3'-� —a'Q � <br /> ►vame: s�rs I� •,gye w�-L <br /> Phone(Pnmary): _ 2 /O—3 0 0�j .. . ,__ <br /> Emeil Address: F}G G�►-�ew � Y�4t-too, �cm�y �._._..._ <br /> Mailing Addr�ess: (/ S` SS� � /1J City: L y�oc,c ry ZIP: E��,� <br /> PROPERTY OWNER iNFORMATiON: ❑chedc here ff property owner ia asrr� s applicarrt <br /> Name: __ �o �o��c x.��D�ntG.�, LL C-, ��s-w�SN A�4�►t�,,NL ��Sss�-nrrE6vl�/ln.�a+ <br /> Phone(Primary): �vl2 � �l'a —3� � ; (,��Z —20'�-4ost ----• • ,_.� <br /> FmeilAddress: p-4�A-�w � y�q../.rp�j. [�1 ' S�nl�t�EV NIANGALltk �Go+�tchS7, N�7 <br /> MeilingAddress: 2�,{o y�pA� �� f , �. � City: tN.��ioC�sZIP: _'�O�` <br /> APPLtCANT/Af3ENT ANDf�R OWNER: <br /> • Agree to provide ap intoRnation requred or requested by the Planning Department, <br /> • AQree to pay addifianat i�ees (st�ff bme�ot covered In the original fee payment)and/or cons�tant expenses incurred 9n <br /> review oi this appticatlon,and <br /> • Ceitify that the ir�forma�on soppli�d is true and correct to the best of his/her knowledge. The appllcaM/Qger�t and property <br /> ownQr recognlze thet they arc solely respor�slbie for submittlng a wmplehe applicatlon being �ware thst upon <br /> ielluro to do so,the�fi�ff has no aiterr�tive but to neject It untll It is complete or to reapmmer�d the request for <br /> denial o!the I�equest re0ardlest of ibt potsr�tlal rnerlt, <br /> • Adcnowledge the�sc�ow Agreemerrt is completed and signed. <br /> • The Ov►mer hereby edcnowledqes end agrees bo th�s application and further authorfzes reesona�rle entry onto tl�e property <br /> by Cily Staff,consultanta,agents, Commisslon and Cound)Members for purposes aF investigstion and verilfcation of thia <br /> request. <br /> • Owner andlor appficar�t/agent aclmowletlge they must be present at all schsduled review meetlnps of the Planning <br /> Commisslod and Councll. I# en applicarrt andlor owner is unable to ettend e scheduled rneetlng, plesse make <br /> arrangements to have an authorized representative sttend in place of the applicant/awner and advise the C+ty Pienner <br /> assigned to your pro)ed. <br /> ApplicantlAgent Signature; ; - pa�; _ '?..�1�_�� <br /> Property Owner Signature: �..<r Date: �-rg�� <br /> Property Owner Signature: D��: <br /> �nce o B ndment/Zone CAang�e APPlkaUor►— ����f Y�� <br /> ��2 # 3 8 5� ��L � � �o�� <br /> �4�QF e�oNo <br />