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PC Exhibit A <br /> City of Orono rr..o vr2011 <br /> Conditional Use Permit ApplicatiolyoFoRONO <br /> Street Address: Application# 7-3 9t 7 <br /> O J,l 2750 Kelley Parkway / 1�f <br /> Q `V/'1 Orono,MN 55356 Date Received: c:: - 7— /7 <br /> A V--,.. Main: 952-249-4600 Staff: �� <br /> fax: 952-249-4616 Fee: $700 e. e, /(v 077 <br /> A Mailing Address: Escrow: $700 / N <br /> P.O.Box 66 <br /> lFl V;, G' Crystal Bay,MN 55323-0066 Notes: <br /> 1KESHOY`� <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applications will not be placed mon Planning Commission Agendas. <br /> SITE LOCATION: FClo ... ( B C.' cie.-S 1 tom..14r cZ 5OO s3-1csc-y,...4-1-..A. P.A. <br /> DESCRIPTION OF REQUEST: S+1S-6A\ G:._ titin en V- clod:. In 44i _ i.,JcL3-lc na,. <br /> (attached additional sbeets at necessary) <br /> APPLICANT INFORMATION: 1!4 check here if Applicant address should be used for billing <br /> Applicant: IJ oc k 301$ L.c..0, <br /> Phone(Primary): 1 60 _ 3 .3.-- 33.i <br /> Mailing Address: A-114:p1144- Ave So. City: 1.1_. ►,-_� ZIP: 55313 <br /> Email: ct..1 e-1C 4 .m \o - .cc lh 'yam•"' <br /> PROPERTY OWNER INFORMATION: r6 check here if Property Owner is same as applicant <br /> 0 check here If Property Owner address should be used for billing <br /> Name: <br /> Phone(Primary): <br /> Mailing Address: City: ZIP: <br /> Email: <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 verification <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 v.: r fail.. J �G`"" <br /> Ap licant Signature: A ^�`� r( Date: <br /> P 9ir/ 1/4 7 <br /> Applicant Signature: - Date: <br /> Property Owner Signature: AVRAFAIW Date: W /7— <br /> Property Owner Signature: T Date: <br /> CUP Application-January 2017 <br /> Page 4 <br /> # 3907 <br />