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City of Orono <br />Variance Application <br />EXHIBIT A <br />Sfreef Address <br />2750 Ke:iey Parkway <br />Orono. MN 55356 <br />Man 952-249-4603 <br />fax 952.249-4516 <br />Mailing Address <br />P O Box 66 <br />Crystal Bay. MN 55323-:Q66 <br />Application » 0^/' '60^' <br />Amount Paid, -ktio bo <br />Staff <br />Fee. . S600 <br />Renewal" <br />m <br />S3C0 <br />After-the-fact 200 Oouoie Fee <br />This application form must be completed in fun App cant v/ill be notified withm 15 days as to the status of tne <br />application Incomplete applications will not be placed on Planning Commission Agendas. <br />PROPERTY INFORMATION: <br />Site Address: “ZOlS" Mams Dgjifg <br />Property Identification Number (PIN); <?<n t*? 1toool <br />(Attach legal description to application if not inc uded on the survey ) <br />Date Property Acquired (month/year): uIqt, □ Yes. I own the adjacent parcels. <br />Present use of property; Residential □ 0:ner_____________________________________ <br />Zoning District: A___________ <br />APPLICANT INFORMATION: (Cam^lete legal na-es and manta! status required fcr each irte'ested party) <br />Name: A ouak <br />Phone (home): <br />Address; <br />Email: A P. Lt <br />Phone (work); ^1^2^ sir -isoo <br />UtsiS s^i -Utoo <br />OWNER INFORMATION: (Complete legal names a*d mar.iai status required for each interested party) <br />Name. b><k«.T < ___ <br />Phone (home): <br />Address: 2.<^zsl <br />Phone (work); JVoo <br />N/«,tw Rgiiys <br />Email: y.i^Q,T ^xrr^ ra-nw<Acr.Fax: <br />DESCRIPTION OF REQUEST: Estimated Project Cost: <br />Describe the request in detail (attach additional sheets if necessary): ____________ <br />$ iZO. OOP <br />U <br />-*rf*o y