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17-3969 <br /> PC Exhibit A <br /> City of Orono <br /> Amendment Application <br /> o Comprehensive Plan I o Ordinance Text 1 o Zoning Change (check one) <br /> Sheet Address: ( Application# 17" 3 /p�p <br /> �- <br /> ..011, 2750 Kelley Parkway <br /> � <br /> f�/ Orono,MN 55356 Date Received: -I 7 <br /> / <br /> Main: 952-249-4600 <br /> Staff; -�t8g <br /> fax: 952-249-4616 Fee: $700 <br /> ...A. Mailing Address: <br /> P.O.Box 66 Escrow: $700 <br /> l G� Crystal Bay,MN 55323-0066 Notes <br /> 41czSHOQ`t <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete appiicati will nt be placed on Planning Commission Agendas. <br /> SITE LOCATION: (f l04vE <br /> APPLICANT INFORMATION:, check here If Applicantshould be used for billing <br /> Applicant: IMPAb tJ ,txl leiad <br /> o'J <br /> Phone(Primary): rL-1f►o.v7305 <br /> Mailing Address: J 7 DOW SIOMS.+5 City: th/r"vm' 4 ZIP: c.$yf <br /> Email: ieektun A <br /> PROPERTY OWNER INFORMATION: lecheck here if Property Owner is same as applicant <br /> liktheck here if Property Owner address should be used for billing <br /> Name: <br /> Phone(Primary): --------- --_____ <br /> Mailing Address: — — <br /> ' City ZIP: <br /> Email: —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 owner <br /> recognize that they are solely responsible for submitting a complete application being aware that upon failure to do so,the <br /> staff has no alternative but to reject it until it is complete or to recommend the request for denial of the request regardless <br /> 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 Planning <br /> Commission and Council. If an applicant and/or property owner Is unable to attend a scheduled meeting, please make <br /> arrangements to have an authorized representative attend in place of the applicant/owner and advise the City Planner <br /> assigned to your project. <br /> • Information will be distributed via email <br /> Applicant Signature: Date: $47 <br /> Applicant Signature: Date: <br /> Property Owner Signature: Date: $4.144%7 <br /> Property Owner Signature: Date: RECEIVED <br /> Amendment App1Icatlon-January 2017 AUG 2 2017 <br /> Page4 # 3 9 b 9 <br /> CITY OF ORONO <br />