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PC Exhibit A
<br /> 17-3948 RECEIVED •
<br /> City of O t.. ,r..; ,
<br /> JUIN 2 0 2017
<br /> CITY OF ORONO
<br /> Conditional Use Perr l; .:, p ;3 , [ catiori
<br /> Street Address: . — Application#„_/ 94
<br /> r \ 2750 Kelley Parkway
<br /> 7n A—vo Orono,MN 55358 Date Received: /p- -,,i4-a
<br /> Main: 952-249-4800 Staff: M�
<br /> fax 85Z-2.16-4818 Fee: $700 ,II lig_ -) p o a,5
<br /> A A4sNogAddess: Escrow: w700 I NA
<br /> 11/114, 10.
<br /> ` P.O.Box88t tiG Crystal Bay,MN b6323-0088 Notes:
<br /> •
<br /> lik
<br /> Please complete. Applicant will be notified within 15 days as to the status of the application.
<br /> Incomplete applications will not In placed on Pic..nriinr Cc,mr:i:oalon Agartuc€.
<br /> SITE LOCATION: �� (OM' , Ili., r+i`t+�,4.
<br /> ^-� .t ....--_
<br /> ` •��DESCRIPTION OF REQUEST: rr' db+t,b1!,yk ►i _C �1 •r N, ' , a ` �''-'�iJ (- ( , � .
<br /> (attached additional shoats at;taco:uari')
<br /> APPLICANT INFORMATION: 1.�,'cI' ck here If Applicant address should be used for bilhini.1 •
<br /> Applicant: ft 4 .. _ �/`` `' r 1 .. -
<br /> ���.-_.L+l,_,__- .2._.5A... 1 sir:'iwi,,,• r1r i'
<br /> Phone(Primary): _ ._,i�- r - a g� - w ,
<br /> Mailing Address: ----*.yo �" t ^" c,:..;,,t- '" Cit < r1 '',,:
<br /> _._ d! _ _ �u u;"'►. r , �.. Y �tS ZIP:
<br /> Email: `S'li', t:.V orfs' s .1k: : �.t . _1- -
<br /> PROPERTY OWNER INFORMATION: heck here if Property Owner is same Ds applicant
<br /> /�
<br /> O check here if Property Owner address�houid be used for billing
<br /> Name: A/e _ H€4,2>i"GS. y.. C - .5°.A-1V
<br /> 64r /17,1/U67/±4._/cx
<br /> Phone(Primary): _..__.. 6/2. - -LfeTl
<br /> Mailing Address: ono Lvt ,ee Ay_e.... Sourtf, -� - C City: Ai P.LS ZIP: 5405-
<br /> Email: _ (2�^rWzf''It?)00cA 17/Pc.. C C.4,01 carr.Al 4.._
<br /> APPLICA,,cm'r AND/OR PROPERTY OWNER:
<br /> o Certify that the Information supplied Is true and correct to the best of hic/her knowledge. The applicant and xoprR
<br /> owner recognize that they are solely responsible for cutmititng a complate applicAton being aware That upon
<br /> failure to do so,the staff has no alternative but to reject It until It Is c. mplote or to eacommend .ha req'ia>=•i frc
<br /> denial of the request regardless of Its potential merit.
<br /> o The Property Owner hereby acknowledges and agrees to this application c.nd furti mar authorizes reasonable entry onto th,3
<br /> property by City Staff,consultants,agents,Commission and Council Members.lir purposes of investigation and verification
<br /> of this request.
<br /> ▪ Property Owner and/or Applicant acknowledge they must In preuent ai ail ochoc ulad review mesti.:gs of th.
<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 pica,of the applicant/owner and advise the City
<br /> Planner assigned to your project.
<br /> Y Information will be distributed via email.
<br /> Applicant Signature: { /11/--4.4-L.:4- i7 tti 6- /7 -/7
<br /> Applicant Signature: ----r-- __ D3ir.
<br /> Property Owner Signature: J Date. 67`f
<br /> Property Owner Signature' uum;:
<br /> CUP Application-January 2017
<br /> Page 4
<br /> # 3 9 48
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