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City of Orono <br />Vafiance Application <br />EXHIBIT A <br />StTB9t Address: <br />2750 Kelley Paritway <br />Ororw MN 55356 <br />Mam: 952-249-4600 <br />tax: 952-243-4616 <br />Ma3if)g Address- <br />P O Box 66 <br />Crystal Bay. MN 55323-4066 <br />Appi«aton# 0/“ <br />Date Received. Q/ZJfO^ <br />Amount Paid; hf/A <br />Staff: jAfJiC€ <br />Fee:S600 <br />Renewal; S300 <br />After-me-fact. S1 200 Dsubie Fee <br />This application form mutt be compileted m fuB. App cant will be noLfied within 15 days as to the status of tre <br />aopliceoon. Incomplete appticatione will not be olaced on Planning Commission Agendas. <br />PROPERTY INFORMATION; <br />Site Address; 6»4 5 oiei iLorvA A-ftXe- <br />Property Identification Number (PIN):’^ >t sx Xo ooA <br />Orono <br />(Attach legal description to application if not included on tne survey.) <br />Date Property Acquired (month/year): ^jbo □ Yes. I own the adjacent parcels. <br />Present use of property: B Residential □ Other____________________________ <br />Zoning District; lA_____________ <br />APPLICANT INFORMATION: (Completa legal na-es and marital status required for each ir^te'ested party) <br />Name: AusrAtA.h. < tcA-A^ f^, TAmpug^______________________ <br />Phone (home); <br />Address; /oLct AgauA <br />Email: <br />_ Phone (work); f ^c,S) - \ SKA <br />OfoAO ■ »-(#J , ^^*361 <br />Fax: <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 />DESCRIPTION OF REQUEST: Estimated Project Cost: <br />Describe the request in detail (attach additional sheets if necessary): _____________ <br />ate__tikts I <br />ler I /VZ-i-m, <br />Ift rtf tU. <br />#2371 V,