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talthit(0 <br /> � <br /> . • <br /> c}-4"`. 51(° <br /> VILLAGE OF ORONO No. <br /> Crystal Bay, Minn. clr/77 <br /> REQUEST FOR SITE EXAMINATION <br /> (Complete in Duplicate) THIS ITEM HAS BEEN <br /> This form to be used in all applications for permits for building,N M e <br /> disposal, rezoning, moving a structure, dividing or consolidating parcels of land. <br /> Type of Application Dividins parcel of land Date 5-18-64 <br /> Owner of Property: Name Wi 71 inn Denny Phone No. GR 3-6994 <br /> Address o g Lake; Minnesota <br /> Applicant (other than owner) Name Gordon R. Coffin Phone No. GR 3-4141 <br /> Address l T,nn� T,a1rP <br /> Relationship to Owner _Surveyor <br /> Location (How do we find it?) : Old Crystal Bay Road 1 mile South of Orono High <br /> Legal Description: Lots 10 and 11 Auditor's Subdivision No. 230 <br /> Date Acquired Ah ut 2C) yrs a ea (sq. ft.) 653,4 (1 Single Ownership? yes <br /> Separate Ownership? <br /> Date of last Division of this PropertyyRe er® auditor' s sathutivisiatt_wa <br /> Do you own anyAdjoining Pro erty? Q ma P <br /> J g p h�fr T)pYl'CtTT rinac not <br /> Action Requested • • . • • ' • ' . - . - - Y • s •_ <br /> r�D nny's house an shote <br /> Attach sketch, plat plan or survey and any additional data,. <br /> 1,7? ., <br /> Signature of Applicant <br /> RECORD OF ACTION TAKEN <br /> Application Received by Date No. <br /> Referred to: Date <br /> Inspection Conducted by Date <br /> Recommendation <br /> Planning Commission - Date Considered Recommendation: <br /> Planning Commission Subcommittee - Date Inspected Chairman <br /> Recommendation a. <br /> Planning Commission - Date Recommendation: <br /> Council - Date s'_ 2 5- 4 s Action Taken ^ <br /> Permit Issued - Date , <br />