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� City of Orono <br /> Cor�ditional Use Permit Application <br /> �� StreerAddress. qPplicatlon# - ` <br /> 2750 Kelley Parkway <br /> O Orono,MN 55356 Date ReCeived; <br /> 4, Maln: 952-249�tfi00 S��: <br /> fa�c 852-249-4616 Fee: <br /> .�, a, M�iUng Address: ESCrow#&$ <br /> '�� , `� P.O.Box 66 <br /> t G Crystal Bay,MN 55323-0066 Permlt Fee <br /> �'��5 K�4'� Notes: <br /> Piease complete. Applicant will be notified within 15 days as to the status of the appiication. <br /> Encomplete applications will not be placed on Planning Commission A�gendas. <br /> SITE LOCATION: _c��j� ��`�1n� � � �}��-� � �� ��`� l <br /> APPLICANT/AGENT INFORMATION: <br /> Applicant Name: � eT� <br /> Phone{Primary}: { <br /> Applicant Email: r �-\u+r� �� `, <br /> Address: �' 1•/` City� ZIP• <br /> Agent Name: AgenYs phone number - <br /> Agent Email: Appliqnt is: Contractor Homeowner {Circle One) <br /> PROPERTY OWNER INFORMATION: �check here if property owner Is same as appllcant <br /> Name: <br /> Phone(Primary): <br /> Mailing Address: City� ZIP� <br /> Email: <br /> APPLICANT/AGENT AND/OR OWNER: <br /> • Agree to provide afl inforttiation required or requested by the Planning Departrne�, <br /> • P�ree to pay additional fees{staff time not covered in the original fee paymerrt) and/or consultant expenses incurred in <br /> review of this appllcation,and <br /> • Certify that the iriforma�on supplied is true and correct to the best of hisTher knowledge. The applicant and owner <br /> reeognize that they are sofety responatble for submltting a complete appllcatlon be[n�aware that upon fallur+e to <br /> do aa,the staff has no aftemative but to reJect It until It Is complete or to recommend the request for denial of the <br /> request regardless of its poterttlsl meri� <br /> • Acknowledge the Escrow Agreemerrt Is completed and signed. <br /> • The Owner hereby acknowledges and agrees to thls application and further authorizes reaspnable entry onto the property <br /> by Cliy Staff,consultants,apents,Commission and Council Members for purposes of investigatlon and verificadon of thls <br /> �� <br /> • Owner and/or Applicant acknowledge thsy must be present at all scheduled revlew meotings ef the Planning <br /> Commission and Councll. If an applicant and/or owner is unable to attend a scheduled meeting, please make <br /> arrangements to have an suthorixed repre�ntative attend in place of the applicant/owner and advise the C3ty Planner <br /> asslgned to your project. <br /> AppiicanUAgent Signature: � �T Date: �- <br /> ��i�� <br /> Applicanfi/qyent Signature: Date: <br /> Property Owner Signature: Date: � 6 <br /> Property Owner Signature: Date: RECE11f�D <br /> CLIP,4ppllceHon-January 2016 AUG 1 ?2�16 <br /> Page 2 <br /> � � � �� � CITY OF ORONO <br />