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City of Orono Variance Application Str4wA : Application #2750 Kelley Parkway Orono. MN 55356 mate Received: ._ 1 12 1 v Main: 952-249-4600 Staff fax: 952-249-4616 4' Mailing Address:G� Fee $700. $70f} ti P.O. Box 66 Escrow: $2,500 Crystal Bay, MN 55323- 0066 Notes: 4 SROs. Please complete. Applicant will be notified within 16 days as to the status of the application. Incomplete applications will not be placed on Planning Commission Agenda. SITE LOCATION: 4$80 County► Road 6 DESCRIPTION OF REQUEST: Addition above existing garage & new septic system (attach additional sheets as necessary) APPLICANT INFORMATION: © check here if Applicant address should be used for billing Applicant: _ Mike Dement e Phone (Primary). 763-451-0892 Mailing Address: 11162 Aberdeen Street NE Unit B Ci!y: Blaine ZIP: 55449 Email: mike asdesi ned4u.corn PROPERTY OWNER INFORMATION: © check here if Property Owner is same as applicant check here if Property Own a ress sho d be us for billin Name: Phone (Primary): Mailing Address: Ci ZIP: Email: APPLICANT AN WOR PROPERTY OWNER: Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and property owner recognize that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete or to recommend the request for denial of the request regardless of its potential merit * The Property Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification of this request. + Property Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the Planning Commission and Council. if an applicant and/or property owner is unable to attend a scheduled meeting, please make arrangements to have an authorized representative attend in place of the applicant/owner and advise the City Planner assigned to your project. ■ Information will be distributed via email. Applicant Signature: Applicant Signature: Property Owner Signature: Property Owner Signature: Variance Application — January 2097 Date: -11' Date: Date: 1/12117 RECEIVED Date: JAN 17 7 Page 4 # 3 9 0 1 CITY OF oRONO w Date: -11' Date: Date: 1/12117 RECEIVED Date: JAN 17 7 Page 4 # 3 9 0 1 CITY OF oRONO