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City of Orono <br />Variance Application <br />EXHIBIT A <br />Street Address: <br />2750 Kelley Parkway <br />Orono, MN 55356 <br />Main: 952-249-4600 <br />fax: 952-249-4616 <br />Mailing Address: . <br />P.O. Box 66 <br />Crystal Bay, MN 55323-0066 <br />Application # 0/ ” 7/ <br />Date Received: ^ Qfi.l/O'-i <br />Amount Paid: <br />Staff: JAAJii^ <br />Fee: 5600_______ <br />Renewal: $300 <br />After-the-fact: 51,200 Double Fee <br />This application form must be completed in full. App'cant 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: <br />Site Address: 64 6 “ d)l<< Z-orua l^oa.<A , Orono , KaJ , <br />itinn Number fPlNI:'^ 'it. - ft K‘X'^%1.0 OOAProperty Identification Number (PIN):"^ 3C. it gx 31> Xo ooA___________________ <br />(Attach legal description to application if not included on the survey.) <br />Date Property Acquired (month/year): 8 ybo □ Yes, I own the adjacent parcels. <br />Present use of property: B Residential □ Other ________________________ <br />Zoning District: g.g. - i6 _____________ <br />APPLICANT INFORMATION: (Complete legal na.-es and marital status required for each interested party) <br />Name: ^ |cft. D~AC(gugs <br />Phone (home): AQt-Q^FiMO_________ Phone (work)^ f S) ~?~A4- - t ^<4. <br />Address: 3.^?5 r> Lot P»g»Af_U . fLpoA. c>ro(\o ^ m»J , •5'3'39(______________ <br />Email: <9 . c-ot^ Fax. ____________________ <br />*v <br />OWNER INFORMATION: (Complete legal names a.'.d marital status required for each interested party) <br />Name: _____________________________ <br />Phone (home): <br />Address: ___ <br />Email: <br />Phone (work): <br />Fax: <br />DESCRIPTION OF REQUEST: ' Estimated Project Cost: $ <br />Describe the request in detail (attach additional sheets if necessary): _________________ <br />1 Ok CC^ ^reiAdorvfl.C P S'eLa. . <br />0 c\Ck ii\ d JL Ia /ic <br />vj H r <br />i#2671 <br />fw^»-r¥