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City of Orono <br /> Conditional Use Permit Application <br /> Street Address: Application# /7- <br /> O2750 Kelley Parkway <br /> OOrono,MN 55356 Date Received: /D// 7cin 7 <br /> Main: 952-249-4600 Staff: 13 <br /> fax: 952-249-4616 Fee: $700 <br /> Mailing Address: <br /> P.O.Box 66 Escrow: $700 / NA <br /> r1 <br /> io <br /> rc, Crystal Bay,MN 55323-0066 Notes: <br /> <tK�5 HO4� <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: Lots 1, 2, 3 BLOCK 1, CASCO POINT ADDITION — ADDRESSES UNASSIGNED <br /> DESCRIPTION OF REQUEST: FILLING IN A FLOODPLAIN <br /> (attached additional sheets at necessary) <br /> APPLICANT INFORMATION: 0 check here if Applicant address should be used for billing <br /> Applicant: LAKE WEST DEVELOPMENT, LLC <br /> Phone(Primary): 952-930-3000 <br /> Mailing Address: 14525 HIGHWAY /, #2b5 City: MINNETONKA ZIP: 55345 <br /> Email: PERRY@LWESTDEV. COM , CURT@LWESTDEV.COM <br /> PROPERTY OWNER INFORMATION: 0 check here if Property Owner is same as applicant <br /> 0 <br /> Name: <br /> RICK (BARBARA)check IENif T Property Owner address should be used for billing <br /> Phone(Primary): 612-790-1800 <br /> Mailing Address: 20 2ND STREET NE City: MINNEAPOLIS ZIP: 55413 <br /> Email: RICKLUPIENT@GMAIL.COM <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 vi •. <br /> Applicant Signature: 1 Date: 47,- <br /> Applicant Signature: Date: <br /> Property Owner Signature: SEE AGENT AUTHORIZATION Date: <br /> Property Owner Signature: Date: _ RECEIVED <br /> CUP Application-January 2017 OCT7 <br /> Page 4 i O <br />