HomeMy WebLinkAbout16-3862 (2732 Caroline Ave)City of Orono
Conditional Use Permit Application
Street Address:
2750 Kelley Parkway
` v/'"1 Orono, MN 55356
Main: 952-249-4600
fax: 952-249-4616
Mailing Address.
P.O. Box 66
Crystal Bay, MN 55323-0066
f:1
Application #
Date
Date Received: �dr
Staff : AA
Fee:
Escrow # & $
Permit Fee
Notes:
Please complete. Applicant will be notified within 15 days as to the status of the application.
Incomplete applications will not be placed on Planning Commission Agendas.
SITE LOCATION:
APPLICANT / AG
Applicant Name:
Phone (Primary):
Applicant Email:
Address:
Agent Name:
Agent Email:
INFORMATION:
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PROPERTY OWNER INFORMATION:
Name:
Phone (Primary):
Mailing Address:
Email:
Agent's phone number
Applicant is: Contractor
ZIP:
Homeowner (Circle One)
Ycheck here if property owner is same as applicant
APPLICANT/AGENT AND/OR OWNER:
• Agree to provide all information required or requested by the Planning Department,
ZIP:
• Agree to pay additional fees (staff time not covered in the original fee payment) and/or consultant expenses incurred in
review of this application, and
• Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner
recognize that they are solely responsible for submitting a complete application being aware that upon failure to
do so, the staff has no alternative but to reject it until it Is complete or to recommend the request for denial of the
request regardless of its potential merit.
• Acknowledge the Escrow Agreement is completed and signed.
• The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property
by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification of this
request.
Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the Planning
Commission and Council. If an applicant and/or owner is unable to attend a scheduled meeting, please make
arrangements to have an authorized representative attend in place of the applicantlowner and advise the City Planner
assigned to your project.
Applicant/Agent Signature: Date:
Applicant/Agent Signature: Date:
Property Owner Signature:—A� Date: j 6
Property Owner Signature: Date: RECEIVED
CUP Application — January 2016
Page 2
AUG 1 7 '2016
CITY OF ORONO
City of Orono
Pre -Application Meeting Form
(This form is to be completed by a City Planner during your pre -application meeting.)
For Office Use n 4
City Planner:
PC Date:
Meeting Datefrime:
Met with:
What is the purpose of a pre -application meeting?
Pre -application meetings aid the applicant in preparing a complete proposal, inform them of the procedures and requirements
of the city code, and identify policies or regulations that create opportunities or problems for the proposal.
PROPERTY INFORMATION-
Site
�,� � ��
Site Address: au/b
Property Identificatio Nu roer (PIN):
Zoning District: Size of Property:
LAND USE
❑ Appeal of I ❑ Commercial Site Plan
Administrative Decision Review
❑ PID
❑ Other:
❑ PUD - Residential
❑ PUD - Commerciz
CONDITIONAL USE PERMIT REQUESTS:
❑ Amend Existing CUP ❑ Commercial / Industrial Use
❑ Gr ding and filling - ❑ Grading and filing -
1 cy or more Wetland and flood plain
nest House / ❑ Institutional
esk Apartment Type:
❑ Comprehensive Plan
Amendment
❑ RPUD, without
subdivision
❑ Duplex Credit per bldg)
❑ Easement / ROW
Vacation,
without subdivision
❑ Zoning Amendments
❑ Grading and filing - with 75 feet of OHWL
includes seawalls and retaining walls) _
❑ Residential /
❑ Renewal of CUP Residential Accessory Use
Applicant's BILLS AND ESCROW: The land use application fee is for city staff time and overhead
Initials: costs only. Owner and/or Applicant shall pay f r consultant expenses incurred in review of
Owner's this application and/or additional st t covered in initial application fee, as well as
Initials: provide an escrow in the amount of _ to g e payment of the above.
OTHER INFORMATION:
*Please note: Your land use or conditional use permit will NOT be accepted without a pre -application
meeting during which this form will be completed by City staff.
Applicant Signature:
Owner Signature:
CUP Application - January 2016
Page 3
Date:
RECEIVED
Date: -
AUG 1 7 2016
CITY OF ORONO
DATA PRIVACY ADVISORY
In accordance with Minnesota State Statute 13.04 Rights of Subjects of Data, Subd. 2, "Tennessen warning", we
would like to inform you that your request for a permit or license from the City of Orono or any of its departments
may require you to furnish certain private or confidential information.
You are notified that:
1. The information you furnish will be used to determine your qualification for the permit or license
requested.
2. You may refuse to supply data, but refusal may require that the City deny the permit or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary
to process the permit or license.
4. If your requested permit or license requires Council action to approve, some information may
become public.
5. You have certain rights under Minnesota State Statute 13.04 (see following page) to review private
data on yourself.
6. Your full name is required to process this application or permit.
First Middle - Last
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Address
A
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City I State Zip Phone
CUP Application - January 2016
Page 8
N0
RECEIVED
AUG 17 2016
CITY OF ORONO