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City of Orono <br /> Site Plan Application PCExhibit A <br /> Street Address: Application# /7-3 g, <br /> 2750q /f► rO Orono, <br /> Kelley Parkway <br /> Orono,MN 55356 Date Received: / -i 1_1=,- / <br /> Staff: <br /> Main: 952-249-4600 <br /> fax: 952-249-4616 Fee: <br /> Melling Address: <br /> P.O.Box 66 Escrow#&$ <br /> Crystal Bay,MN 55323-0066 Permit Fee <br /> <10SH0V-8' 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/Agent: D.J. Kranz Co., Inc./Bruce Quam, President <br /> Phone(Primary): 763-525-0100 <br /> Mailing Address: 725 Highway 169 North Plymouth,MN 55441 <br /> Email: bquam@djkranz.com City: ZIP: <br /> PROPERTY OWNER INFORMATION: 0 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: pastorioren@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 authoriz representative attend in place of the applicant/owner and advise the City Planner <br /> assigned to your project. <br /> -444 <br /> Applicant/Agent Signature: Date: <br /> Applicant/Agent Signature: Date: <br /> Property Owner Signature: - Cv . Date: /2//3//� <br /> Property Owner Signature: Date: <br /> RECEIVED <br /> Site Plan Application-January 2016 DEC 14 2016 <br /> Page 2 <br /> ;1 3 8 88 CITY OF ORONO <br />