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City of Orono Variance Application 61OA : Applicat n # / 7- 39',00 rso Kerrey Parkway Orarro, MN 553$6 6 Date Received: /—/7—/7 Staff: M C— Main: e52 -24945o© tax 952-248.4818 Fee: 799-0 Maffing Addraw P.O. Box 66 Escrow # & $ Ta o Crystal Bay, MN 65823-0066 Permit Fee Notes: Please complete. Applicant will be notified within 15 days as to the status of the application. Incomplete applications will not be placed on Planning Commission Agenda. l SITE LOCATION: �V� ell q !I &VA DESCRPTION OF REQUEST: a' i all 1 1'a d�yCri}; lrAS . (attached additional sheets as necessary) APPLICANT / AGENT INFO ATl N: Applicant Name }i h&hAcC Phone (Primary): .. l fq S Applicant Email: A f-, LofA Address: C : trltde ZIP: j' i31 Applicant Is: Contractor Homeowner (Circle One) PROPERTY OWNER INFORMATION, 0 check here if property owner is same as applicant Name: Rs, MvA A. f.;PYu, Phone (Primary): 6- Z3 7, & G -- -- - Mailing Address: d- Ci a ZIP: Email: APPLICANT/AGENT ANDIOR OWNER: • Agree to provide all Information required or requested by the Planning Department, • Agree to pay addillwal fees (staff time not covered In the original fee payment) and/or consultant expenses incurred in review of this application, and • Certify that the information supplied is true and correct to the best of hislher knowleciga. The applicant and owner mcognite 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 maria • Acknowledge the Escrow Agreement is completed and signed. • The 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 vari6cation of this request • Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the Planning Commission and Council. If an applicant andror owner is unable to attend a scheduled rneeling, please make arrangements to have an authorized representative attend in place of the appiiocanNowner and advise the City Planner assigned to your prolec t. AppfcarWAgent Signature: 1 ApplicantlAgent Signature: Property Owner Signature: Date: Property Owner Signature: Data, Variance Asolieation —Bray 2016 �2 RECEIVED JAN I .2017 '3 9 0 0 CITY OF ORONO