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City of Orono Land Use Permit Application Application # / Date Received: Staff : Fee: Escrow # & $ Permit Fee Notes: PC Exhibit A Please complete. Applicant will be notified within 15 days as to the status of the application. Incomplete applications will not be placed on Pllaanjn�ing Commission Agendas/cSf. 5?/ SITE LOCATION: 90 {. re sJk1 ek1 I fV4 i : V Q � dZ ��U !�t �� df6/ et 1W&)0t-/APPLICANT 1 AGENT INFORMATION Applicant Name: t� -11�) - _ri�)_ Phone (Primary): a — ' L — I Applicant Email: -Hect-- Address: Agent Name: Agent Email: ILW O ZIP: 5S -SS -to Agent's phone number Applicant is: Contractor omeown (Circle One) PROPERTY OWNER INFORMATION: Xcheck here if property owner is same as applicant Name: Phone (Primary):�, Mailing Address: Lac �A-jeqyyl+U Email: ' APPLICANTIAGENT AND/OR OWNER: • Agree to provide all information required or requested by the Planning Department, ZIP: • 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 authori d representative attend in place of the applicant/owner and advise the City Planner assigned to your protect. 7 Applicant/Agent Signature: �JCu I dl%�t�L Date: Applicant/Agent Signature: , ` J r Date: Property Owner Signature:[ ��t�jyt4 Date: Property Owner Signature: Date: Land Use Application — May 2016 Page 2 • SEP 2 E 701r CITY OF ORONO Street Address: t1 a /i rO 2750 Kelley Parkway Orono, MN 55356 Main: 952-249-4600 fax: 952-249-4616 .1 �5 Mailing Address: 'S + P.O. Box 66 \F G Crystal Bay, MN 55323-0066 Application # / Date Received: Staff : Fee: Escrow # & $ Permit Fee Notes: PC Exhibit A Please complete. Applicant will be notified within 15 days as to the status of the application. Incomplete applications will not be placed on Pllaanjn�ing Commission Agendas/cSf. 5?/ SITE LOCATION: 90 {. re sJk1 ek1 I fV4 i : V Q � dZ ��U !�t �� df6/ et 1W&)0t-/APPLICANT 1 AGENT INFORMATION Applicant Name: t� -11�) - _ri�)_ Phone (Primary): a — ' L — I Applicant Email: -Hect-- Address: Agent Name: Agent Email: ILW O ZIP: 5S -SS -to Agent's phone number Applicant is: Contractor omeown (Circle One) PROPERTY OWNER INFORMATION: Xcheck here if property owner is same as applicant Name: Phone (Primary):�, Mailing Address: Lac �A-jeqyyl+U Email: ' APPLICANTIAGENT AND/OR OWNER: • Agree to provide all information required or requested by the Planning Department, ZIP: • 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 authori d representative attend in place of the applicant/owner and advise the City Planner assigned to your protect. 7 Applicant/Agent Signature: �JCu I dl%�t�L Date: Applicant/Agent Signature: , ` J r Date: Property Owner Signature:[ ��t�jyt4 Date: Property Owner Signature: Date: Land Use Application — May 2016 Page 2 • SEP 2 E 701r CITY OF ORONO