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City of Orono <br />Vacation Application <br />Street Address: <br />2750 Kelley Parkway <br />Orono, MN 55356 <br />Main: 952-249-4600 <br />fax: 952-249-4616 <br />Mailing Address: <br />P.O. Box 66 <br />Crystal Bay, MN 55323-0066 <br />Application # <br />_ <br />Date <br />❑ <br />Received: <br />Application fee <br />Staff <br />3 <br />Fee <br />sm= <br />Escrow: <br />Vas. <br />Notes: <br />Fees assume IL <br />Data privacy form <br />application not part of <br />6 <br />subdivision. <br />I ! We request an Easement or Right of Way onlor adjacent to the following property be vacated: <br />PROPERTY INFORMATION: <br />Site Address: <br />Submittal Requirements <br />❑ <br />1 <br />Completed Vacation Application <br />❑ <br />2 <br />Application fee <br />❑ <br />3 <br />Escrow de oz and a reem ,nt <br />❑ <br />4 <br />Survey (meeting ALL re uiremenisI Click for the City's Survey and Site Plan R uirernents. <br />❑ <br />5 <br />Data privacy form <br />D <br />6 <br />Hardcover Calculation worksheets. Click hers for the City's Hardcover Information Packet. <br />❑ <br />7 <br />Additional Information re nested by City Staff <br />❑ <br />1 8 <br />1 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: <br />Phone (primary): <br />Mailing Address: <br />City, State & ZIP <br />Email: <br />• Agrees to pay additional fees (staff time not covered in the original fee payment) andfor 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 hislher 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 Cky 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 Counc P. If an applicant andlor <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 />Property Owner Signature: Date: <br />Property Owner Signature: te: <br />Vacation Application — January 2017 <br />