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City. of Orono <br /> Conditional Use Permit Application <br /> Street Address: Application# / 7-3 <br /> SO/�TO 2750 Kelley Parkway <br /> b Orono, MN 55356 Date Received: i a—I 4- 1 <br /> Staff: <br /> Main: 952-2494600 <br /> fax 952-249-4616 Fee: 70c) Ct- 74t/ 9' <br /> Mailing Address: <br /> P.O.Box 66 Escrow#&a�4 �5� ��G oZaUlo <br /> G� Crystal Bay,MN 55323-0066 Permit Fee <br /> ikEs H 04� 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: 3745 Shoreline Drive <br /> APPLICANT/AGENT INFORMATION: <br /> Applicant Name: D.J. Kranz Co., Inc./Bruce Quam, President <br /> Phone (Primary): 763-525-0100 <br /> Applicant Email: bquam@djkranz.com <br /> Address: 725 Highway 169 North City: Plymouth,MN ZIP: 55441 <br /> Agent Name: Bruce Quam Agent's phone number 763-525-0100 <br /> Agent Email: bquam@djkranz.com Applicant is: Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: ❑ check here if property owner is same as applicant <br /> Name: Good Shepherd Lutheran Church <br /> Phone (Primary): 952-471-8433 <br /> Mailing Address: 3745 Shoreline Drive City: Wayzata, MN ZIP: 55391 <br /> Email: pastorloren@goodshepherdmn.org <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. .r/ <br /> Applicant/Agent Signature: Date: <br /> Applicant/Agent Signature: Date: <br /> Property Owner Signature: j - - Date: / /.,S' /�p <br /> Property Owner Signature: <br /> RE ED� <br /> CUP Application-January 2016 DEC 1 4 2016 <br /> Paget Et 3 8 88 <br /> CITY OF ORONO <br />