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City of Orono <br />Conce <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 />lication <br />Application # <br />Date <br />Received: ! <br />Staff : <br />Fee: $3to.00 <br />Notes: <br />�p �.al �1 "-I <br />Applicable regulation Section 78-47. Concept plans may be accepted for proposed amendments to the <br />Comprehensive Plan, the Zoning Ordinance, or the Zoning Map. <br />Submittal Checklist: <br />1 <br />Completed 8RUcation <br />2 <br />1 Application flee <br />13 <br />3.:.- <br />Site Plan <br />❑ <br />4 <br />Building Pla <br />5 _ <br />Nan afr,* <br />6 <br />7 <br />8 <br />Additional information you feel helps describe the project <br />-.Data p0yacy form <br />Additional information re quested by C' <br />Electronic M of all submitted materials via ernafu. CD or flash drive,. <br />9 <br />PROPERTY INFORMATION:�ir1L'� <br />Site Address: <br />PROPERTY OWNER INFORMATION: 1I" r✓ t h e "ej r <br />Name:i <br />d Phone (primary): r 2� l'�ri 4r B�•s "'� a <br />Mailing Address:Li29it) I It, W-i <br />City, State & ZIP Scr t!-s" 0 �L $5' & � <br />.r Email: /'n -�-�.._--.._._ .._ <br />oQnoFQTv r�arrrue�, <br />• Agrees to pay additional fees (staff time not covered in the original fee payment) and/or 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 his/her 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 altema&e <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 />4L The Property Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property <br />by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification of this request. <br />• Applicant acknowledges they roust be present at all scheduled review meetings. If an applicant and/or owner is unable to attend a <br />scheduled meeting, please make arrangements to have an authorized representative attend in place of the applicantfowner and <br />advise the City Planner assigned to your pnAea <br />• Information will be distributed via email. <br />v"Property Owner Signature: <br />//Property Owner Signature:,` <br />Concept Application -- January 2017 <br />Date: 2 <br />Date: <br />SE'P 2 0 Z017 <br />3977 CITY OF ORONO <br />