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City of Orono <br />Variance Application <br />I'--� <br />Q j�r <br />StrsetAddress: <br />2750 Kelley Parkway <br />Orono, MN 55356 <br />Application # <br />Date Received <br />Main: 952-249-4604 <br />Staff <br />fax: 952-249-4615 <br />Mailing Address. <br />Fee <br />v <br />Escrow # & $ <br />P.O. Box 66 <br />G� <br />4 ti <br />Crystal Bay, MN 553234M <br />Permit Fee <br />S H o <br />Notes <br />PC <br />Exhibit A <br />#17-3887 <br />Please complete. 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: 1�94xms+ k+ r , :fie. <br />(attached additional sheets <br />APPLICANT / AGE T INFORMATION: <br />Applicant Name: ,viS C. ~ � <br />Phone (Primary): - Si46o <br />Applicant Email: _ j6hn 0 r -Y U 19' bra 0A1r� <br />Address: 1,53 � z 1,'d s+ <br />Applicant is: on ra Homeowner (Circle One) <br />PROPERTY OWNER INFORMATION: <br />Name: <br />Phone (Primary): <br />Mailing Address, <br />Email: <br />necessary) <br />❑ check here if prooerty owner is same as annlicant <br />I-V Ju -".- <br />ZIP: '�'53e <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.I applicant and/or owner is unable to attend a scheduled meeting, please make <br />arrangements to have an aut rized presentative attend in place of the applicant/owner and advise the City Planner <br />assigned to your project. <br />ApplicantlAgent Signature: Date: <br />Applicant/Agent Signature: Date: <br />Property Owner Signature: Date: <br />Property Owner Signature: <br />Variance Application - May 2016 <br />Page 2 <br />Date: <br />OEC 14 2016 <br />CITY OF ORONO <br />