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City of Orono <br />Variance Application <br />EXHIBIT A <br />Sfreef Address: <br />2750 Kelley Parkway <br />Orono. MN 55356 <br />Application # 0^'f' <br />Amount Paid; <br />Date Received: <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 />Staff: <br />Fee;S600 <br />Renewal: $300 <br />After-the-fact; 51.200 Double Fee <br />This application form must be completed in full. App icant 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: Vyz.\\j(S. <br />Property Identification Number (PIN); o<\\ \'^ z i.ooo3. <br />(Attach legal description to application if not included on the survey.) <br />Date Property Acquired (month/year): \tlo3» □ Yes, I own the adjacent parcels. <br />Present use of property: Qi Residential □ Other ___________________________ <br />Zoning District: l.9.1 a__________ <br />APPLICANT INFORMATION: (Complete legal na-as and marital status required for each interested party) <br />'lame: (jth.’iS ^ AoutK ____________________________________ <br />•hone (home)- __________________________Phone (work): (^sz) s-^l ~/soo_______ <br />Address: Lmoi Suvp <br />Email: A P Ki\ii-ia . c,o\r<r\Fax: r-ti^oo <br />OWNER INFORMATION: (Complete legal names c'd marital status required for each interested party) <br />Name: C?A»g.T ^ 'icn-z.iS.e._______ <br />Phone (home): f‘is?.) <br />Address; 2.C»2.g Ntfv.TH 54^q-c. Vajup <br />Email: <br />Phone (work): C&iz\ S'o&-anoc <br />Fax: <br />DESCRIPTION OF REQUEST: Estimated Project Cost: $ \ 2,o^ qoq <br />Describe the request in detail (attach additional sheets if necessary):______________________ <br />It II <br />—t.* <br />O <br />>-/