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PC Exhibit A <br /> City of Orono <br /> Conditional Use Permit Application <br /> Street address: Application# <br /> O 2750 Kelley Parkway <br /> CI Orono,MN 55356 Date Received: 1,2pA (o(i.0.4, <br /> Staff: <br /> Main: 952,249-4600 1 <br /> fax: 952-249-4816 Fee: <br /> Maikng Addrass: Escrow#&$ <br /> y; I f <br /> s, P.O.Box 66 <br /> or G -0066 Crystal Bay,MN 55323Permit Fee <br /> 441s1108 Notes: <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applications will not be placed on Planning Commission Agendas. <br /> SITE LOCATION: 3S$0 1'lor -\%,nom. 'Dv t•-•(_. 4 4 rorn0 MN 63•:;‘‘ <br /> APPLICANT/AGENT INFORMATION: <br /> Applicant Name: So.reon V. Yt..1 tlizrna•,r• Cot.,t4r2. Cmcr.J‘•-1(.1 WI%vNK"4 yr,-c,ni-) <br /> Phone(Primary): Ly11» Sot L, b"151 <br /> Applicant Email: Soor00r1.Ko.vc.l a 1ne nY rV•veN•u s <br /> Address: llvpc) PrdwAc. privt City: yslcd.‘►n2 ZIP: 55340 <br /> Agent Name: Agent's phone number <br /> Agent Email: Applicant is: Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: .INFORMATION: )4 check here if property owner is same as applicant <br /> Name: _ \'1C vv..,CP.d'• C - -- So. - ll-pay.t.\ <br /> Phone(Primary): OO <br /> Mailing Address: City: ZIP: <br /> Email: <br /> APPLICANT/AGENT AND/OR OWNER: <br /> • Agree to provide all information required or requested by the Planning Department, <br /> • Agree to pay additional fees (staff time not covered in the original fee payment)and/or consultant expenses Incurred in <br /> review of this application, and <br /> • Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner <br /> recognize that they are solely responsible for submitting a complete application being aware that upon failure to <br /> do so,the staff has no alternative but to reject it until It is complete or to recommend the request for denial of the <br /> request regardless of its potential merit. <br /> • Acknowledge the Escrow Agreement is completed and signed. <br /> • The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property <br /> by City Staff,consultants,agents, Commission and Council Members for purposes of investigation and verification of this <br /> request. <br /> • Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the Planning <br /> Commission and Council, If an applicant and/or owner Is unable to attend a scheduled meeting, please make <br /> arrangements to have an authorized representative attend In place of the applicant/owner and advise the City Planner <br /> assigned to your project. <br /> Applicant/Agent Signature: j..\... <br /> Date: t I 3 o l 1u' <br /> Applicant/Agent Signature: Date: ll <br /> Property Owner Signature: Date: i g 0 t ILP <br /> Property Owner Signature: Date: RECEIVED <br /> CUP Applica6on-January 2016 <br /> Page 2 DEC 1 2 201R <br /> # 3886 CITY OFORo <br />