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City of Orono <br /> Conditional Use Permit Application PCExhibit A <br /> ^ Street Address: Application# /7- 39/D <br /> (t /�0 Orono, <br /> Kelley Parkway _ <br /> " Y Orono,MN 55356 Date Received o7-a/-/7 <br /> • Main: 952-249600 Staff <br /> Nilli <br /> fax: 952-249 4616 Fee $700 <br /> • <br /> ,, -� Mailing Address: Escrow' $700 I NA ^1J <br /> 'S� P.O.Box 66 A�� <br /> G� Crystal Bay,MN 55323-0066 Notes U <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: 324C Wayza{ .—Nvice1 Ok MA 6-53 <br /> r <br /> DESCRIPTION OF REQUEST; OUP- V k gmnq 4' 1 t ecya/,iYi€.. <br /> (attached ad tion I sheets dt neces ary) <br /> APPLICANT INFORMATION: Wcheck here if Applicant address should be used for billing <br /> Applicant: kat'Fw 1- 1-1-(..- <br /> Phone(Primary): -0 i- r_mI <br /> Mailing Address: 4 5 g4cy moi' - ;7 ,rj " City: 'U961c i ZIP: 56Email: 04(f Gv 1w 4-de , (Tovn doll() 1 stcleY (?om <br /> PROPERTY OWNER INFORMATION: �eck here if Property Owner is same as applicant <br /> ❑check here if Property Owner address should be used for billing <br /> Name: PA j) t LIX <br /> Phone(Primary): q52-930- an <br /> Mailing Address: _ i j , 4 t ' - ' C.� , � ��_� ZIP: _ ..r <br /> Email: <br /> 1�ud- @ILwe ev,eon� OM •jwe51- eY, Crnrt1 <br /> APPLICANT AND/OR PROPERTY OWNER: <br /> • Certify that the Information supplied is true and correct to the best of his/her knowledge. The applicant and property <br /> owner recognize that they are solely responsible for submitting a complete application being aware that upon <br /> failure to do so,the staff has no alternative but to reject it until It is complete or to recommend the request for <br /> denial of the request regardless of its potential merit. <br /> • The Property Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the <br /> property by City Staff,consultants,agents,Commission and Council Members for purposes of investigation and verfication <br /> of this request. <br /> • Property Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the <br /> Planning Commission and Council. If an applicant and/or property owner is unable to attend a scheduled meeting, <br /> please make arrangements to have an authorized representative attend in place of the applicant/owner and advise the City <br /> Planner assigned to your project. <br /> • Information will be distributed via m 'I. <br /> Applicant Signature: - �� Date: 0.2/2o�aol7 <br /> Applicant Signature: Date: / <br /> • <br /> Property Owner Signature: .6:; t�--J Date: (�l/d?U` O(7 <br /> Property Owner Signature: Date: ` l <br /> CUP Application-January 2017 RECEIVED <br /> Page 4 <br /> FEB 21 2017 <br /> # 3 9 10 CITY OF ORONO <br />