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City of Orono <br />Variance Application <br />EXHIBIT A <br />Street Aciress <br />2750 Ketley Parkway <br />Orono. MN 55355 <br />^1a‘, 952-249-4500 <br />fax: 952-249-46*6 <br />Matfr.g Adaress <br />P O Box 65 <br />Crystal Say. MN 5532:-::5S <br />App! catch's <br />Date Receiveo <br />Anount Fa d (_cCO C<} <br />Sta" ________ <br />Fee 5500 <br />Renewal. S300 <br />Afte'-the*fact St 2C0 Ccuc e "ee <br />7dts aopiicaton form must be corrpieico in fjM. App leant will be ro'i^.ec with n *5 days as to tre sta’LS cf t^e <br />application Incomplete applications will not be placed on Planning Commission Agendas. <br />PROPERTY INFORMATION: <br />Site Address. *Z-trl^ <br />‘ <br />3'.^Lit r-- <br />.-'>1Property Identification Number (PIN); _________ <br />(Attach legal description to application if not inc’uded on the survey ) <br />Dale Property Acquired (month/year). _______□ Yes, I own the adjacent parcels <br />Present use of properly: )0.^esidenlia! <br />Zoning District; L^-1 fe ________ <br />□ Other <br />/V <br />Phone (^rk): Cl.S^ ~7M(yr-L-MI 2 <br />APPLICANT INFORMATION; (Cc-^p ete legal na-es and ma'itai status reputed for eacn mte'es ’ed party) <br />Name; O<fj ^3 IMCfJ,- <br />Phone (homef ( ) <br />Address- 3C:^lS Yell _______________________________________________ <br />Email: lipSCf f-^Fax: _____________________ <br />OWNER INFORMATION: (Complete legal na-ncs z-z manta: status regu.red for each rtorosted party) <br />Name: ^______________________________________________________ <br />Phone (home); <br />Address: <br />Email <br />Phone (work); <br />DESCRIPTION OF REQUEST: Estimated Project Cost; S <br />Describe the request in detail (attach additional sheets if necessary). _________________ <br />r^: <br />>. .'■i "2-crf . y h L J '- TC* I'- <br />y^\rr:' lO <br />M gTTiir-rfcc- JT^ \A^rr <br />M c' A o O <br />Inr