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PC Exhibit A <br /> 17-3933 <br /> City of Orono SCANNED <br /> Vacation Application ._ <br /> Street Address: Application# / 7- 393,3 <br /> LOBO 2750 Kelley Parkway Date <br /> r Orono, MN 55356 RECEIVED Received: 3-02.9-/7 <br /> - Staff: �8 <br /> Main: 952-249-4600 Fee $700.00 <br /> y fax: 952-249-4616 MAR 2 9 2017 Escrow $700.00 <br /> G, Mailing Address:P.ONotes: Fees assume <br /> t�k sH0�� Box 66 OF ORONO application not part of <br /> Crystal Bay, MN 55323-ooe5 subdivision. <br /> I/We request an Easement or Right of Way on/or adjacent to the following property be vacated: <br /> PROPERTY INFORMATION: <br /> Site Address: /14033i40-1OP-i-K5ITYLI3V-1VAD <br /> Submittal Requirements <br /> 1 Completed Vacation Application <br /> 13f. 2 Application fee <br /> I 3 Escrow deposit and agreement <br /> '®; 4 Survey(meeting ALL requirements) Click t for the City's Survey and Site Plan Requirements. 5-VV,A11 L <br /> '1S. 5 Data privacy form <br /> '. 6 Hardcover Calculation worksheets. Click r€rr for the City's Hardcover Information Packet. E'`V A A I L <br /> ❑ 7 Additional Information requested by City Staff <br /> ❑ 8 Electronic copy of all submitted materials via email, CD or flash drive. <br /> PROPERTY OWNER LNFORMATION: (Complete legal names and marital status required for each interested party) <br /> Name: Irl , i.-1 1\)p I,— k1ial-r-_ - <br /> Phone(primary): 602_q-71— 9x33 <br /> Mailing Address: .44134- 6,12.1 Ste, d l2..b <br /> City,State&ZIP Cj1Z,‘,1 )O M.N.) 5----. q I <br /> Email: C'we..e 1-0 Ma ri . 0 byvi <br /> PROPERTY OWNER: <br /> • Agrees to pay additional fees(staff time not covered in the original fee payment)and/or consultant expenses incurred in review of <br /> this extension application,and <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner recognize that <br /> they are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no altemative <br /> but to reject it until it is complete or to recommend the request for 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 property <br /> ' by City Staff,consultants,agents,Commission and Council Members for purposes of investigation and verification of this request <br /> • Property Owner acknowledge they must be present at all scheduled review meetings of the City Council. If an applicant and/or <br /> owner is unable to attend a scheduled meeting,please make arrangements to have an authorized representative attend in place of <br /> the applicant/owner and advise the City Planner assigned to your project. <br /> • Information will be distributed via email. ...---"---7 <br /> Property Owner Signature: �, Date: <br /> �- .3i7 l))7 <br /> Property Owner Signature: : Date: <br /> RECEIVED <br /> Vacation Application-January 2017 <br /> 1 MAR.292017 <br /> # 3 9 3„,.,.7 <br /> CITY OF ORONO <br />