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City of Orono Variance Application StreetAddress: 2750 Kelley Application # /7 - Parkway Orono, MN 55356 Date Received Main: 952-249-4600 staff fax: 952-249-4616 Fee '70-C MailingAddiess: Escrow# & $ P.O. Box 66 Crystal Bay, MN 55323-0066 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. SITE LOCATION: 20'10 5HOP-151-1t4ra P&Iye . &KaN c c5 i; S-1 I DESCRPTION OF REQUEST: &MMAWLE F-AbM rtie AVEMern LAKFESKOXE -sb-TI5bc, (attached additional sheets aVecessary) SU -4 b — 12 -f I c L'A IYEEATTA614 P mrr-LILPAIM I I A"r-N I lNrUKMA I ION: Applicant Name: L-AtAgEL. VliA-AKr-> AF -GV Phone (Primary): 612.2 - 313 - 91L — Applicant Email: 1AMy-e—Je* 1"M1 tAll . C-0 Address: 0+19 L�10CAW AVB. -4. Applicant is: Contractor Homeowner (Circle One) PROPERTY OWNER INFORMATION: Name: Phone (Primary): Mailing Address: Email: T e C-1 ty-&� — A PZH I Trze, 13 check here if property owner is same as applicant 01 APPLICANTIAGENT AND/OR OWNER: • Agree to provide all information required or requested by the Planning Department, • Agree to pay additional 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 his/her knowledge. The applicant and owner recognize that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no altemative but to reject It until it is complete or to recommend the request for denial of the request regardless of its potential merit. • 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 verification 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 and/or owner is unable to attend a scheduled meeting, please make arrangements to have an authorized representative attend in place of the applicantlowner and advise the City Planner assigned to your project. Applicant/Agent Signature: Applicant/Agent Signature: Property Owner Signature: Property Owner Signature: Vadance Application — May 2016 -,MAP Page 2 /-16- 2,011 Date: - RECEIVED JAN 18 2017 # 3904 CITY OF ORONO