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City of Orono <br /> Concept Application <br /> Street Address: Application# =1r►4=moi <br /> r��O�j 2750 Kelley Parkway Date '. j ' .� <br /> O Orono, M N 55356 Received: )C r <br /> .., , Staff. �%� <br /> tri` Main: 952-249-4600 l=ee: ,� 0 <br /> ';'s. <br /> a y fax: 952-2494616 <br /> '�� f{ �'� MaNng Address: Notes: pp__ I -14.41 <br /> .00� <br /> G P.O.Box 88 S alt ( -1 l 4"1 <br /> j�kkSHO�� Crystal Bay, MN 55323-0066 <br /> Applicable regulation Section 7847. Concept plans may be accepted for proposed amendments to the <br /> Comprehensive Plan,the Zoning Ordinance,or the Zoning Map. <br /> Submittal Checidist <br /> ' . .1 completed Application <br /> /._. <br /> Application fee <br /> $. Site Plan <br /> 4 Building Pla <br /> Bim' 5 „Narrative T-' <br /> g--- 8 Additional information you feel helps describe the project <br /> 7 Data privacy form <br /> ❑ 8 Additional information requested by City <br /> Cil 9 Electronic copy of all submitted materials via email.CD or flash drive. <br /> - 1 <br /> PROPERTY INFORMATION:r 01 ;'I (-vine's I LZi <br /> Site Address: /�aa �3t(Ac( E7E1 pial !AAI 6k 14'') gerr3Ckl <br /> PROPERTY OWNER INFORMATION: Mereeidliitel;e4 r <br /> Name: i 1•...--# i•'%Q;%-.4 ..c �- G?04-1e- ,4 j e el rt. <br /> ,,i Phone(primary): — 6,;-4., B��•� t'A�'`t' <br /> ,/ Mailing Address: t1a7 -3 6 to q "./ tic <br /> r/ City.State&ZIP ! <br /> scarts.rsjc �Z Ss.Q6 a <br /> • Email: 6 thenscn(3) c ' rne=t'- ct,i rd.._ J.. I! <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 alternative <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 /> • Applicant acknowledges they must be present at aft scheduled review meetings. If an applicant and/or owner Is unable to attend a <br /> scheduled meeting, please make arrangements to have an authorized representatIve attend in place of the appbcant/owner and <br /> advise the City Planner assigned to your project. <br /> • information will be distributed via email. <br /> "'Property Owner Signature: ,� J Date: <br /> Li f 7z 7 <br /> +/Property Owner Signature:r' t� r <br /> �►F4... .. _... Date:� i/J7-//7 e[ D <br /> Concept Application—January 2017 <br /> SEP 2 0 2017 <br /> 1 # 3977 <br /> CITY 0F ORONO <br />