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City of Orono <br /> Conditional Use Permit Application <br /> Street Address: Application# <br /> Q O/� rO 2750 Kelley Parkway <br /> T� ��/6111L".- Orono, MN 55356 <br /> Main: 952-249-4600 <br /> Staff <br /> fax: 952-249-4616 Fee: $700 <br /> Mailing Address: Escrow: $700 / NA <br /> S P.O.Box 66 Date Received: <br /> ✓� <br /> � Crystal Bay, MN 55323-0066 Notes: <br /> `� OV:" <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: /0 47 c Ft v AA- .Jko'd4 Wts4--1 Ov,iip 3 q <br /> DESCRIPTION OF REQUEST: 5(( ktthet t ' I/"p15GYiptiJ),. e1- RC f U-€S1' 4. Pn)rcf /V1111-1,) <br /> (attached additional sheets at necessary) <br /> APPLICANT INFORMATION: O check here if Applicant address should be used for billing <br /> Applicant: 7p- 12.G�+k4vviP L vsoHi Retikawip 1,411,56kItVa .l k <br /> Phone (Primary): b 12 . ?As-. -4.7'1-5- <br /> Mailing Address: S/.52_ yet 43 " Sf City: Alp 1s ZIP: y/ D <br /> Email: 7��t... _ V 4 (-2 p t •01r5 c • G ei-,ti_ <br /> PROPERTY OWNER INFORMATION: 0 check here if Property Owner is same as applicant <br /> jllrcheck here if Property Owner address should be used for billing <br /> Name: '1:3di f01€s <br /> Phone (Primary): 952 - Zyd - 21" <br /> Mailing Address: 2, s't0 evesG.,+ /i R02,1 City:it{/Jim iatka ZIP: S'c0 c <br /> Email: W{-p1eS JD it e 70I• C ._.._ <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 vi. email. <br /> 1' <br /> Applicant Signature: ----/ ----,N___/_/ <br /> / /Date: '7 • 1 <br /> Applicant Signature: Date: <br /> Property Owner Signature- Pi 4--- -- 0 Date: , _7/ r ---dl <br /> Property Owner Signature: Date: <br /> CUP Application-January 2017 <br /> Page 4 <br />