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City of Orono <br />Variance Application PC Exhibit A <br />SbuW Addrew: <br />Apiallodon # '5410? <br />2750 Kelley Parkway <br />Orono, MN 55M <br />Date ReoGfved: <br />Win- 952 -249 -Mo <br />stffff : <br />fax: 9W -Ug -ale <br />Fee: <br />hlb"Address. <br />P.O. BOX as <br />EwAm ft. & $ <br />CMftl Bay, MN 5M3 -M <br />Perm it Fee <br />Notm: <br />Please complete. Applicant will be notified within 15 days as to the status of the application. <br />incornprets appitcafdons will jrLot be placed on Planning Commission Agenda. <br />SITE LOCATION: SS 2-0 —�N V i:v F- 9- 4;--- L V., <br />DESCRPTION OF RECKJEST: ��areA + wt qn;oih vAiAar%cfD <br />(attached additional sheets as necessary) <br />APPLICANT I AGENT INFOW;ATION: <br />Applicant Name: 6 L -k ta tAc <br />Phone (Pdmary): fist ZITO a �S�[ <br />Applicant Email: r-LAne- I w- CM le-- I jn%-La. Q-0—rn <br />Address: AtAO%JaV- P_gj, h <br />41-9a:q City: MQLAtA4 zip: <br />Applicant is: Contract= Homeowner JC!rcls One) <br />PROPERTY OWNER INFORMATION: )fcheck here if property owner is same as applicant <br />Name: <br />Phone (Primary): <br />Mailing Address, City: ZIP: <br />Email: <br />APPLICANTIAGENT AND/OR OWNER: <br />Agree W provide all inforrnatlon required or requesied 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 applicagon, 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 ore solely mponsible flor subrnMng a complo% aPpliceflon being aware that upon fallure to <br />do m ft sftff has no aftemeWe but to reject It until It In complete or to reco(nmend the request for denial of the <br />requed regardless of Its potential madt <br />Acknowledge the Escrow Agreement is completed and signed. <br />The Owner hereby acknowledges and agrees to this applicallion and further authorizes reasonable entry onto the property <br />by City Staff, consultants, agents. Commission and Council Members for purposes of Investigation and v"cation of this <br />requesL <br />t, Owner andfor Applicant acknowledge they must be preserd at all scheduled review meetings of #* PlannIng <br />Commisellon and Council. If an applicant and/or owner is unable to attend a scheduled meeting, plesse make <br />arrangements to have an authorized representsfive attend in place of the applicant/owner and advise The City Planrmr <br />assigned to your project <br />Applicant(Agent Signature: Date: <br />Applicent/Agent Signature: oopdir-ol Date: <br />Property Owner Signature: Date: <br />Property Owner Signature: <br />"ECE D <br />V&WwAfiAk8ffw-AftyW1G paw 2 #3908 FES 0 7 2017 <br />cnyOFORONO <br />