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City of Orono ^9at a- <br />Variance Application______ <br />Street Address: <br />2750 Kelley Parkway <br />Orono, MN 55356 <br />Main; 952-249^00 <br />tax: 952-249-4616 <br />MaHing Address: . <br />P.O. Box 66 <br />Crystal Bay, MN 55323-0066 <br />Application# OS'3 f 3^ <br />Date Received: jjQ/9 ~0^ <br />Amount Paid: Q O <br />Staff: Ja <br />Fee: S600 <br />Renewal: $300 <br />After-the-tact $1,200 Double Fee <br />This application form must be completed in full. Applcant will be notified within 15 days as to the status of the <br />application, incomplate applications will not be placed on Planning Commission Agendas. <br />PROPERTY INFORMATION <br />Site Address: <br />Property Identification Number (PIN): <br />fididuC PrxrisZ. ^cl <br />(Attach legal description to application if not included on the survey.) <br />Date Property Acquired (month/year): 3/^2. □ Yes, I own the adjacent parcels. <br />Present use of property: □ Residential □ Other_______________________ <br />Zoning District: _________________ , <br />APPLICANT INFORMATION: (Complete legal nar.es and marital status required for each interested party) <br />Name: f)RM LAk ^iV\ ^ / <br />Phone (home): 6 Phone (work): Co- m ^ <br />W tZtoociAddress <br />Email:Fax: '^^9^ <br />OWNER INFORMATION: (Complete legal names sr.d marital status required for each interested party) <br />Name: __________________________________ <br />Phone (home): Phone (work):__________________ <br />Address: ^^LiAJr Pic /LJ. __________________ <br />Email: Fax: <br />DESCRIPTION OF REQUEST: Estimated Project Cost: $ <br />Describe the request in detail (attach additional sheets if necessary): _____________ ' <br />i % o <br />« <br />_____i