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City of Orono <br />Variance Application <br />EXHIBIT A <br />Street Addfoss: <br />2750 Kelley Parkway <br />Orono. MN 55356 <br />liJLJ <br />Main: 9S2-249-46C0 <br />fax: 952-249-4616 <br />Mailing Address: . <br />p.o. Box ee <br />Crystal Bay, MN 5532^4066 <br />Application# OH <br />Date Received: <br />Amount Paid: iJi-oO, cro <br />Staff: ' <br />Fee:5600 <br />Renewal: 5300 <br />After-the-fact 51,200 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. Incomplete applications will not be placed on Planning Commission Agendas. <br />PROPERTY INFORMATION: .. a j <br />Site Address; /3 ‘74J> ^ <br />Property Identification Number (PIN): <br />(Attach legal description to application if not included on the survey.) <br />Date Property Acquired (month/year): ;>iSI □ Yes, I own the adjacent parcels. <br />Present use of property: p Residential □ Other <br />\J^\^Zoning District: <br />APPLICANT INFORMATION: (Complete iegal nar.es and marital status required for each Interested party) <br />lame: OUcir\^ccy fb f H \Jdhn^')r^. _______________________________________________________________________ <br />IPhone (home): IPI'I- tjyTi _____Phone (work): <br />Address: "7J151 A/’g. • 4? H^mhCilfooUSt . fi/iN <br />Email: Fax; <br />OWNER INFORMATION: (Complete legal names and marital status required for each interested party) <br />Name: ^ ^ Johf^5oy) <br />Phone (home): if 12^- ^ <br />Address: '1^51 { K\/)ni') <br />12^’ 9m- lp9li <br />An/z. < <br />__Phone (work): <br />Email:Fax: <br />DESCRIPTION OF REQUEST: Estimated Project Cost; $ <br />Describe the request In detail (attach additional sheets if necessary): ________________ <br />Q