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• <br /> City of Orono <br /> Conditional Use Permit Application A <br /> Wo 2760 ICAddison: Appkoabon# /7- 39i 1J <br /> Ig <br /> 2760 Kaley Palmy <br /> Orono,MN 55356 Dale Received ,7-,r1,/-/ <br /> Mehr 952.24x4600 <br /> Staff <br /> fez 952,246 4616Aladin g Fee $700 <br /> t oN, 7 , PA.Ike 3700 / NA -1): <br /> C� SHaq�G � MN 553230066 Nobs <br /> y <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applications will Planning Commission Agendas. <br /> SITE LOCATION: ..lZ4t OA y zaitC7Sival Oka")a '.5 <br /> MA/53550 <br /> !55&P <br /> DESCRIPTION OF REQUEST:PP- c� in 41l�Kev!/lm <br /> (attached rrl sheets ) <br /> APPUCANT INFO • : lathed(here ifApplicant address should be used for billing <br /> Applicant a 1_ . ' / _ <br /> Phone(Primary): ' a - <br /> Mailing Address: L'!.r, 1/agX. ' 1 111111111t07/% .. ,d'''lri_Wili_lrs •• <br /> Emelt 4 = ide . it.III <br /> PROPERTY OWNER INFORMATION: l>itlieck here If Property Owner Is game as applicant <br /> �0 check here if Property Owner address should be used for billing <br /> Name: J <br /> Phone(Primary): S <br /> 30-3� <br /> Mailing Address: Ai/!, Jay 7- .s!Lirte. p.a5- ��/� ZIP: , .5.--34/5-- <br /> Email: <br /> lin,. ,PI ,e'Om c P( rlev. (Tr)m <br /> APPLICANT AND/OR PROPERTY OWNER: <br /> • Certify that the Information supplied is true and correct to the best of hislher knowledge. The applicant and property <br /> owner recognize that they are safely rosperraile for submitting a complete application being aware that upon <br /> Mune to do so,the staff has no&emotive but to reject B until It Is complete or to recommend the request for <br /> denial ratite request regardless of its potential merit. <br /> • The Property Owner hereby acknowledges end 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 Invesagallon and verification <br /> of this request <br /> • Properly <br /> OCornrnlssiora Applicant <br /> I acknowledge y mast be present at all scheduled review meetings of the <br /> applicant and/or property owner Is uneble to attend a scheduled meeting, <br /> please make arrangements to have an authorized representative attend In piece of the appiltldorrrner and advise the City <br /> Planner assigned to your project. <br /> • Information will be distributed via 'I. <br /> Applicant Signature: Date: 42/20/02N7 <br /> Applicant Signature: Date: <br /> Property Owner Signature: ,411�"-- r.� Date: NI/JO/40g <br /> l <br /> Property Owner Signature: Date: <br /> CUP A <br /> ca °n-January2017 RECEIVED <br /> Poe 4 <br /> FEB 21 2017 <br /> # 3910 crrY <br />