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Fee <br />Case No. <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota <br />(Complete in Duplicate) <br />This form to be used in all applications for special use permits and <br />for rezoning, dividing or consolidating parcels of land, vacating <br />streets, alleys and variances. <br />Type of Application I - Date /•S l v <br />Owner of rope ty:,Name hone No y <br />33k� lckfc %ji Address ,G <br />Applicant (other than owner): N tc /, Phone No. <br />Address _�- <br />Relationship to Owner <br />Engineer: Name hone No. <br />Land Planner: Name Phone No. <br />Subdivider: Name Phone No. <br />Location (How do we find it?) �1����/ G,.,; %f•�r�".[!rC_ <br />Legal Description: f � l;4 <br />ng aersn1K P^` <br />Date Acquired Area (sq.ft.) /� H� 5 Separate Ownership v <br />Date of last division of this property <br />Do you own any adjoining property <br />Action Requested 1,e„ tc <�{ �-►� ,¢« ����z/^ ���°yzi3 <br />Signature of Applicant <br />RECORD OF ACTION TAKEN <br />Date Action <br />Inspection Dept:: /,Y- G SS C!!'(&'EV_�lc - At -,—e e.- <br />Administrator: s'. s y _ 4 6_ e' � '! _ <br />Village Council: ,� � l 6 � �z-�.�F X 3 . a ' <br />7� <br />Village Engineer: <br />Village Attorney: <br />Planning Commission: �_ f,-_ C a�C.,/�. i3 - s i <br />Village Council: <br />Permit Issued: Date <br />