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City of Orono RECEIVED Conditional Use Permit A l i� JuL 2 0 2016 p p at i WIFORONO Street Address: / �S� 2750 Kelley Parkway Application # yO Orono, MN 55356 Date Received: PC Exhibit A Main: 952-249-4600 Staff fax: 952-249-4616 Fee: µ Marling Address: P.O. Box 66 Escrow # & $ t+� Crystal Bay, MN 55323-0066 Permit Fee HD�� Notes: 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. SITE LOCATION:. e�ocQ o APPLICANT 1 AGENT INFORMATION: Applicant Name:L Phone (Primary): f Applicant Email: Address: �j4 m [' Cit AWZIP: ,- Agent Name: i .�e Agent's phone number ZIG Agent Email: f",�,� it. Applicant is: Contractor Homeowner (Circle One) PROPERTY OWNER IN R ATIQN: 13 check here if property owner • same as pplic nt Name: j'� u� PVL [� w r Phone (Primary): Z, Mailing Address: v Fes, L 5� City: ,�• ziP; Email: i-!6— t C- T APPLICANVAGENT AND/OR OWNER: • Agree to provide all information required or requested by the Planning Department, • 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 alternative 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 represent attend in place of the applicant/owner and advise the City Planner assigned to your project. Applicant/Agent Si Date: 2�f� Applicant/Agent Signature: Date % Property O ner Si nature: Date: r� Prope y er Signature: C Date: CUP Application - January 2016 Page 2 # 3856