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City of Orono - <br /> Variance Approval Extension <br /> Application <br /> Str�eet Address: Original / � �. <br /> �Q,�O 2750 Kelley Paricway Variance# <br /> Orono, MN 55356 Date h /, / <br /> Received: (J �/ ! <br /> Main: 952-249-4600 Staff: <br /> ,� fax: 952-249-4616 1�'Extension: $ <br /> 'S�, � Mailing Address: administrative a roval <br /> L P.O. Box 66 2"�&3�' $350 <br /> `�kESH��� Crystal Bay, MN 55323-0066 Extensions: (Counal approval) <br /> Th�extansion appiica�an i�rm must be c�r►pl�tad in tul!and subrrritted s�t lenst 60 days prlor expiratlon dsite ot <br /> ths vAris�nca. In no case shall more than thres,ons year extensions be granted. <br /> Ori�inal Variance Numbsr: /( - �` a�3 Approval date !t �!� � � �o <br /> PROPERTY IN�'ORMATION: <br /> Site Address: $d S M'�1n Avc�a-� Oro»� , /�� S'S�3 4 ! <br /> PROPERTY OWNER INFORMATION: <br /> Name: �.1a.��� � '�...�.�.. 'Z��ae.L��l <br /> Phone(primary): ,�/�- 8 G�- - �Z Y 4 <br /> Mailing Address: g� S,�„•}.� ,��,, <br /> City, Stabe 8 ZIP c���� t Mw� �t'3 g 1 <br /> Email: r g \o.c.�- w<<l 'a.8 � a�-K:\, c��-. <br /> PROPERTY OWNER: <br /> • Agrees to pay addfional fees(staff time not oovered in the original fee payment)and/or consultant expenses incurred in review of <br /> this extension application,and <br /> • Certfies that the mformation supplied is Vue and�rt�ect to the best af his/her knowledge. The applicaM and owner recognize that <br /> they ane solely responsible for submitting a complete applica6on being aware that upon failure to do so,the staff has no alternative <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 /> • The Property Owner hereby acknowledges and agrees to this applicatwn and further autFw�izes reasonable entry onto the property <br /> by City Staff,consultants,agents,Commission ar�Council Members for purposes of investigation and verification of this request. <br /> • Property Owner acknowledge they must be preserrt at all scheduled review meetings of the City CounaL If an applicant and/or <br /> owner is unable to attend a sd�eduled meeting,pl�se make atrangements to have an authorized representative attend in plaoe of <br /> the applicant/owner and advise the City Planr��assigned to your project. <br /> • Information will be distributed via email. <br /> Property Owner Signature: ate: �v�� �� � <br /> Property Owner Signature: Date: �� ���y <br /> Variance Approval Extension—January 2017 <br /> 1 <br />