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RECENED <br /> PC ExhlbltA JU� � � Z01� <br /> City of Orono <br /> Condit�onal Use Permit Application°F°R°"° <br /> �11r� �� . . - � <br /> 2750�iey Parkway APPN�on# <br /> O►ono,MN 55358 �aEe ReCeived: ' <br /> � a . <br /> AAsln 951-249-48pp S�'� : <br /> taoc: 862-249-46'16 Fee: ` - �- <br /> .� M.arr,aaad►�ss: .. f":.�. <br /> '��, `� P.a.Booc 96 Est�'CW#8�$ . <br /> 1,�,+Y'�S g O��G �Ys��B�Y,MN 563Z3-0096 Permit Fes � . <br /> ( Notse: ! <br /> Please complefe. Applicanf will be notif"�ed within 15 days as to the status of the application. <br /> lncomplete applications will not be placed an Planning�Commission Apendas. <br /> SITE LOCATlON: _ 3� l��s}�a{1� �.�e;�-� ���, M N <br /> APPLICANT/AKiENT INFO Tf0 : � <br /> Applicarrt Neme: r O <br /> Phone{Primary): — �.�. � � <br /> APPlicsrrt Email: � <br /> Addr�ess: Cf : ZIP: -�js?j <br /> Aperrt Name: AgenYs phone number <br /> ABent EmaiL Applicant Is: Contractor Homeowner (Circie Onej �.}.�y� <br /> PROPERTY OWNER INF RMI�Tt�N: ❑check ere if prope ov►mer is sa as a plicant � <br /> Neme: G l e S � <br /> Phone(Primary): p— <br /> Mailing Ad�ess: d. 0 Z1P: <br /> Ema�: <br /> APPLICANfilA6ENT AND/OR OWNER: <br /> • Apree to provide a!I[nfarmation required or requested by the Piannin�Departrnent, <br /> . Apree to pay addidonal fees(stsdf time not covered in the originai fee paymeM)end/or consultarrt e�enses in�urred in <br /> review af this application,and <br /> • Certiiy that the irrformatien supp�ied is true and comact to the best af hisJher Imowledge. Th�appt(cant and pvmer <br /> recopnlze that they are solely respoR$Ible 1br submitting a comptebe appllcation be1nQ aws�re that upon tallure b� <br /> do so,the stai[has no albemative but bo rojeet it undf it Is complate or to recommer�d the request for deNaE of t1�e <br /> ss4uest repardless M Its pobentlal me�ft <br /> • AclmowledQa the Exrow Agreement is completed and stgnad. <br /> • The Ovmer hereby aciv�owiedgss end agrees to this eppficalion and further authorizes reasonable e�ry onto the property <br /> bY C�f+�,��suttants,apente, Commisslon and Courtal Members far purposee ot investipstion and verification of this <br /> requesk <br /> • Owr�er arxf/or Appllcant ackne�wledpe lhsy must be present at ali scheduled review rneetlnps of the PlanMny <br /> Commisslon and Coundt. If an appficerrt and/or owner is unabie to attend a �cheduletl meettn0, please meke <br /> erranDeme�ta have an etltl�or¢ed represetrtative attend in place of the appl'�t/owner and advise the City pE�ner <br /> e�ssigned to your project � <br /> Applicanf/Agertt Signafure: Date: <br /> App[icant/AgeM Signature: �` � °`' � Date: (r /L�z o i�` <br /> � <br /> Property Ovmer Signature: Date: <br /> Property Owmer Signature: Date: <br /> CUP APplycatlon—.lenuery 2016 � <br /> Pa�e 2 <br /> �' '� �� ��n0 �OCa�I (,e ru4Sf— ��- �v�4,t�.P. . cSyt,+e.l� a o� <br /> �ru s � K S <br /> q��- a-�� <br />