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PC <br /> Exhibit A <br /> #17-3986 <br /> City of Orono <br /> Conditional Use Permit Application <br /> Street Address: Application# / 7 - 3 9 <br /> oKelley Parkway <br /> Orono, <br /> OrMN 55356 Date Received: -/ 7-77— <br /> Main: 952-249-4600 Staff <br /> fax: 952-249-4616 Fee: x$7015 76 ysQ_ <br /> Mailing Address: Escrow: $700 I NA <br /> P.O.Box 66 <br /> Fl + C> Crystal Bay,MN 55323-0066 Notes: <br /> 4/C sHos- <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applications will not be placed on Planning Commission Agendas. <br /> SITE LOCATION: I'L10 (hit -LtiZ —TVOL- i n ki 55 <br /> DESCRIPTION OF REQUEST: Cl Re-Rs (4}{1/4L :-r ?LuIJf <br /> (attached additional sheets at necessary) <br /> APPLICANT INFORMATION: OS check here if Applicant address should be used for billing <br /> Applicant: -De--S014 <br /> Phone(Primary): 10114,5 et(' -144,082; <br /> Mailing Address: Iq--(� �" <br /> �t � IQA�L City: IypsANp ZIP: 55364 <br /> Email: -tY0.�,x3_ '�0 1 otvr. <br /> PROPERTY OWNER INFORMATION: el.check here if Property Owner is same as applicant <br /> 0 check here if Property Owner address should be used for billing <br /> Name: "'raA.vn L�1F�t�iJ� <br /> Phone (Primary): tact f Sct% 91,158 <br /> Mailing Address: 12jt0 1,.U1Wt}Lt,9-51"'T'Qp�1L - City: Mou.k..st ZIP: 55* <br /> Email: +aimiS_K...d pnya h r at:t1 <br /> 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 <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: �----".L/ Date: /0-/D-/ 7 <br /> Applicant Signature: 1 i... LArtiE'&i -9!1I'-b-$34.3 Date: <br /> Property Owner Signature: /�r .--- Date: /19-/0 -/7 <br /> Property Owner Signature: Date: RECEIVED <br /> CUP Application-January 2017 Pegs 4 OCT 1 f 2011 <br /> # 3 9 8lb CITY OF ORONO <br />