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AatheNlskgn ID $00 Gomm <br />City of Orono <br />Subdivision Exception Application <br />SlraatAddrass: <br />Applimlion # <br />2750 Way Parkway <br />Orono. MN 55356 <br />Date Received: <br />Staff <br />Main: 952 249-4600 <br />fax 952-2494516 <br />Fee: <br />Ma&V A6*4= <br />Notes: <br />P.O. BOX 66 <br />CrysW Bay. MN 55323.006E <br />SITE LOCATION(S): {)(A [ La7 _ V)&r�[S . 2-1„ <br />PROPERTY OWNER 1 IN <br />Name: j <br />Phone (primary): _ <br />Mailing Address: _ <br />Email: _ <br />PROPERTY OWNER 2 INFORMATION, <br />Name: /17.7ek 4 L <br />Phone (primary): <br />Mailing Address: <br />Emafl: <br />O.W <br />ZIP: <br />n - 14rld"1 G4 M dL'^'e'- <br />ZIP: <br />APPLICANT INFORMATION <br />Same as Property Owner 1 or Property Owner 2 (dreie one) above; Or <br />Name: <br />Phone (primary): ZIP. <br />Mailing Address: <br />Email: <br />• Certifies that the information supplied Is true and correct to the best of his/her knowledge. The applicant and owner recognize <br />that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no <br />atte nBe" but to reject it urrtg it is complete or to recommend the request for denial of the request regardless of its potential <br />merit. <br />• The Property Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the <br />property by City Staff, consultants. agents. Commission and Council Members for purposes of investigation and verification of <br />this request. <br />41 Mfornu don will be distrbAed via <br />Property Owner 1 Signature: Suxe Yadd"A `Q <br />Property Owner 1 Signature: 1= <br />Property Owner 2 Signature: I <br />Property Owner 2 Signature: QA4120171,7:,a A, 1 <br />211�20172:11'53 P►1 CST <br />ApplicantSignature: ' l- <br />Applicant Signature: <br />Subd&*bn ExcepWn App colon Packet— January 2017 <br />Pape 2 <br />12/1412017 <br />Date: <br />Date: <br />Date: <br />Data: µ"!u It <br />Date: IL-9-17 <br />Date: <br />