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PC <br /> Exhibit A <br /> #17-3975 <br /> City of Orono <br /> Conditional Use Permit Application <br /> - O/�j Street Address: Application# a''7— .off G <br /> ` rla O Orono,MN 52750 Kelley Parkway <br /> 56 Date Received: ( 3 [G7 /—f <br /> Main: 952-249-4600 <br /> Staff: 1 /1,G <br /> fax: 952-249-4616 Fee: $700 <br /> Me�7ing Address: Escrow: $700 / NA <br /> y 1 A. P.O.Box 66Ttl , <br /> G� Crystal Bay,MN 55323-0066 Notes: <br /> I'kESHOR�c <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applications" will be placed on Planning Commission Agendas. <br /> SITE LOCATION: 1'-4 W t 0 er m 1�3rJ)kI o�r,MAI 55511 <br /> DESCRIPTION OF REQUEST: c i!)P fob PP At4et�F I P 1 IA N6 Lod <br /> (attached additional sheets at necessary) <br /> APPLICANT INFORMATION: .4 chec here if Appli nt address should be used for billing <br /> Applicant: weLi7V (vt <br /> Phone(Primary): -7‘,7.,2q <br /> Mailing Address: ( (la t f;Z,CN 4,/W City:[11(jj`joNtAZIP: 553 , <br /> Email: _ Li 1Y n pl,lryn./Ir GODI <br /> PROPERTY OWNER INFORMATION: *check here if Property Owner is same as applicant <br /> ❑checkh re if Property Owner address should be used for billing <br /> Name: � 1 A/1 )+ANN <br /> Phone(Primary): (Dej( 17-ag5a <br /> Mailing Address: 14'- C (ZD <br /> EN F,k, A City:WNW:TOM OIZIP: 5N.3 -5 <br /> Email: � 1Qn6021 D,SQA %nal i. G0m <br /> APPLICANT AND/OR PROPERTY OWNER: u <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: ''._4L i f!. .4l/4 Date: a . 1q '03/7 <br /> � .. . t <br /> Applicant Signature: f t'' _. -! ■�t!� � Date: <br /> Property Owner Signature: L <br /> Shrift. ,ii las+>' Date: "l , P '�)7 <br /> Property Owner Signature: • Date: <br /> CUP Application-January 2017 RECEIVED <br /> Page 4 <br /> SEP 19 2017 <br /> 3975 enry 8R°RONO <br />