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City of Orono Item #02 - PC Agenda - VE D File #16-3848 [Tota ages PC Exhibit JUN 2 2 20185 Conditional Use Permit Application OFORONO S&IwtAddress 2750 Kelley Parkway Application # Orono, MN 55356 D81:6 Rbiceived: - —/ Main: 952-249-4600 Staff fax: 952-249-4616 Fee: �- Mailing Address: P.Q. Box 56 Escrow # & $ Crystal Bay, MN 5532340066 Permit Fee jNotes: Please complete. Applicant will be notified within 15 days as to the status of the application. Incomplete applications will not be placed on Planning Commission Agendas. r%.1 - - a - - SITE LOCATION: APPLICANT I AG Applicant Name: Phone (Primary): Applicant Email: Address: Agent Name: Agent Email: PROPERTY OWNER INF RM�TION: ID check fere Name: G Phone (Primary): ro ` p Mailing Address: a Email: Applicant is: Contractor owner is APPLICANTIAGENT AND/OR OWNER: • Agree to provide all information required or requested by the Planning Department, Homeowner (Circle One) qr") !cant • Agree to pay additional fees (staff time not covered in the original fee payment) and/or consultant expenses incurred in review of this application, and • Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner recognize that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no altemative but to reject it until it Is complete or to recommend the request for denial of the request regardless of its potential merit Acknowledge the Escrow Agreement is completed and signed. • The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification of this request. • Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the Planning Commission and Council. If an applicant and/or owner is unable to attend a scheduled meeting, please make arrangements to have an authorized representative attend in place of the applicant/owner and advise the City Planner assigned to your project. ��LJ L. Applicant/Agent Signature: Date: Applicant/Agent Signature: Date: ry a Property Owner Signature: Date: Property Owner Signature: Date: CUP Wicafion - January 2016 P 2 slM q/ iaat