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Council Exhibit A <br />City of Orono <br />Variance Application <br />Street Address: <br />Application # <br />2750 Kelley Parkway <br />Orono, MN 55356 <br />Date Received; <br />Staff <br />Main: 952-249-4600 <br />fax 952-249-4616 <br />Fee: <br />Mailing Address: <br />Escrow # & $ <br />P.O. Box 66 <br />Crystal Bay, MN 55323 -OM <br />Permit t=ee <br />Notes: <br />Please oompiete. Applicant will be notified within 15 days as to the status of the application. <br />Incomplete applications will not be placed on Planning Commission Agenda. <br />SITE LOCATION: <br />DESCRPTION OF REQUEST: <br />APPLICANT / AGI <br />Applicant Name: <br />Phone (Primary): <br />Applicant Email: <br />Address: <br />Applicant is: Cor <br />sheets as necessary) <br />PROPERTY OWNER INFORMATION: <br />Name: <br />Phone (Primary): <br />Mailing Address: Ci ZIP: <br />Email: <br />bCf5heck here if property owner is same as applicant <br />APPLICANT/AGENT AND/OR OWNER: <br />• Agree to provide all information required or requested by the Planning Department, <br />• Agree to pay additional fees (staff time not covered in the original fee payment) and/or consultant expenses incurred in <br />review of this application, and <br />• Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner <br />recognize that they are solely responsible for submitting a complete application being aware that upon failure to <br />do so, the staff has no alternative but to reject it until It is complete or to recommend the request for denial of the <br />request regardless of Its potential merit. <br />• Acknowledge the Escrow Agreement is completed and signed. <br />• The 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 <br />request. <br />• Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the Planning <br />Commission and Council. If an applicant and/or owner is unable to attend a scheduled meeting, please make <br />arrangements to have an authorized representativ attend in place of the applicanVowner and advise the City Planner <br />assigned to your project. <br />} <br />Applicant/Agent Signature: Date: 1 <br />ApplicantlAgent Signature: LL_AL�'Date: 11,11&4v, a, <br />Property Owner Signature: <br />Property Owner Signature: <br />Variance Application — May 2046 <br />ti <br />Date: <br />Page z NOV 17 2016 <br />«TMor-°Ro"° # 3885 <br />