Laserfiche WebLink
PC <br /> Exhibit A <br /> #17-3928 <br /> City of Orono <br /> Conditional Use Permit Application <br /> Street Address. Application# <br /> rO A>O 2750 Kelley Parkway Date Received: <br /> � Orono,MN 55356 <br /> Staff: <br /> Main: 952-249-4600 <br /> fax: 952-249-4616 Fee: $700 <br /> ,� t_ Mailing Address: Escrow: $700 / NA <br /> y Po.Box ss <br /> F �G� Crystal Bay,MN 55323-0066 Notes:`gkfSHOI� <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: Z. S t C., c_ -s C(-) f` c , ..:_ A YC <br /> DESCRIPTION OF REQUEST: C Lf / C� <—�i- I . v--�. I -MI .C-- `.. -1C <br /> (attached additional sheets at necessary) <br /> APPLICANT INFORMATION: check here if A plicant address should be used for billing <br /> Applicant: /s---• .. I I ( ..�,_-N- <br /> Phone(Primary): Zv/ -z-- --.. 4,..- -4, S€'1Mailing Address: •Z i c> G.;--s,T., SO,,, _. 1 V-1 City: c-u-o ZIP: 5.STf1 I <br /> Email: r=• Ke— 1,--..— Ar- o. r ,.C...,� ,tip.-ter .--% .. --,--I-- <br /> PROPERTY OWNER INFORMATION: check here if Property Owner is same as applicant <br /> check here if Property Owner address should be used for billing <br /> Name: Sc ,_ rte. -_ <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 via email. <br /> Applicant Signature: /� _I Date: Th - L I - (----) <br /> Applicant Signature: �) Date: <br /> Property Owner Signature: —�/ " / /--.. Date: T - Z r - (-Th <br /> Property Owner Signature: Date: <br /> CUP Application-January 2017 <br /> Page 4 <br />