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PC <br /> #17-3983 <br /> City of Orono Exhibit <br /> Vacation Application <br /> Street Address: Application# I r1- 3 C1 '3 <br /> 2750 Kelley Parkway Date <br /> 0 Orono, MN 55356 Received: q" ))-7-1 7 <br /> Main: 952-249-4600 Fitt $700.00 <br /> fax: 952-249-4616 Escrow: $700.00 <br /> "S' Mailing Address: <br /> P.O. Box 66 Notes: Fees assume <br /> Hp�' application not part of <br /> 'fk <br /> Crystal Bay, MN 55323-0066 subdivision. <br /> I/We request an Easement or Right of Way on/or adjacent to the following property be vacated: <br /> PROPERTY INFORMATION: <br /> Site Address: <& Cir-SC.-v <br /> Submittal Requirements <br /> in 1 Completed Vacation Application _ <br /> ❑ 2 ••lication fee <br /> , N 3 Escrowfitmosit and agreement <br /> ❑ 4 Surve meetin• ALL re•uirements Click here for the C' 's Surve and Site Plan Re•uirements. 2 <br /> ■ 5 Date privacy form <br /> 0 6 Hardcover Calculation worksheets. Click here for the City's Hardcover Information Packet. <br /> © , , 7 Addtbnati intarnalion requested by City Stan <br /> ❑ 8 Electronic copy of all submitted materials via email, CD or flash drive. <br /> PROPERTY OWNER INFORMATION: (Complete legal names and marital status required for each interested party) <br /> Name: � C Lt Z_ o <br /> Phone (primary): v G 57TtE'0wt -- <br /> �p/ — . ,O 9GO 0 <br /> Mailing Address: Z / G4-4,S co poi N-' 120/ <br /> City, State &ZIP j„g y z }4141,.3SS3 t l <br /> Email: LTG4e_ AL VoLgSrgvb1_ C�c.►� <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 /> • Property Owner acknowledge they must be present at all scheduled review meetings of the City Council. If an applicant and/or <br /> owner is unable to attend a scheduled meeting,please make arrangements to have an authorized representative attend in place of <br /> the applicant/owner and advise the City Planner assigned to your project. <br /> • Information will be distributed via email. , <br /> Property Owner Signature: v Date: l-' -7_ / -7 <br /> Property Owner Signature: Date: - <br /> RECEIVED <br /> Vacation Application--January 2017 SEP 2 72017 <br /> 1 # 39 8 <br /> CITY of oRorvo <br />