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City of Orono <br /> Conditional Use Permit Application PCExhibit A <br /> Street Address. I Application# /7 39/D <br /> V...0/A 1 2750 Kelley Parkway <br /> ` 0 Orono,MN 55356 Date Received' a7-.2-/-/9 <br /> ANL, Main: 952-249-4600 <br /> fax: 952-249-4616 Fee $700 <br /> IA MaiP.O.Box ling Add66ress: Staff <br /> Escrow: $700 / NA <br /> Crystal Bay,MN 55323-0066 i Notes <br /> Please complete. Applicant will be notified within '15 days as to the status of the application. <br /> Incomplete applications will -noott be placed on Planning Commission Agendas. <br /> SITE LOCATION: 3243 l uayzc k (�t/Cf-', � '�-vw ,-5 <br /> M/I550 <br /> DESCRIPTION OF REQUEST: OUP- d ! tthq eccyz/iii1q (7L <br /> (attached ad tonal sheets at necessary) <br /> APPLICANT INFORMATION: CI check here If Applicant address should be used for billing <br /> Applicant: In Q KP(UP f" 1-1-0-- <br /> Phone(Primary): 9'5, _ 36-�`3C.�2'_) <br /> Mailing Address: 11/13' J� m l 7 8GLrk-#265— City:77b,!6th4L ZIP: 5.5'71-5-- <br /> Email: <br /> 1?uJJi c IfA) ' e , Poor) rinho t�/L112 eY 0on-i <br /> PROPERTY OWNER INFORMATION: J ck here if Property Owner is same as applicant <br /> / 1 ❑check here If Property Owner address should be used for billing <br /> Name: 1n.C!~IC�Lc_*PS! Lie 1 <br /> Phone(Primary): S - 3p- <br /> Mailing Address: /sf 5" 'l, ! Y , i1e. ,cam Cit :/rf. / ZIP: <br /> Email: ii,. ,ig . - -t ! / g iJ e a/ <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 andior 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 ' <br /> Applicant Signature: Date: azp.Q/0.7cv7 <br /> Applicant Signature: Date:.(2rr <br /> Property Owner Signature: Date: OZ/Ay.7/0(7 <br /> Property Owner Signature: Date: <br /> CUP Application-January 2017 RECEIVED <br /> Page 4 <br /> FEB 21 2017 <br /> 3910 CITY OF ORONO <br />