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City of Orono <br />Variance Application <br />Street Address: <br />2750 Kelley Parkway <br />Application # <br />Orono, MN 55356 <br />Date Received: <br />Main: 952 249.4M <br />Staff <br />fax 952 249-4616 <br />Mailing Address. <br />Fee: <br />P.O. Box 66 <br />Escrow:$ <br />ig1 <br />Crystal Bay. MN 55323-0066 <br />Notes: <br />Please complete. Applicant will be notified within 15 days as to the status of the application. <br />Incomplete applications will/ not be placed on Planning Commission Agenda. <br />SITE LOCATION: <br />DESCRIPTION OF OF REQUEST: v <br />(attach additional sheets as necessary) <br />APPLICANT INFORM ff N: check here if Applicant address should be used for billing <br />Applicant: --I <br />Phone (Primary): Z -- <br />Mailing Address: 2�6 1 (,p K e g—FQ C ZIP: <br />Email: �_�, t�Ttr <br />PROPERTY OWNER INFORMATION: ❑ check here if Property Owner is same as applicant <br />Name: <br />O check here if Property Owner address should be used for billing <br />r3lz-j�r, �� <br />Phone (Primary): <br />Mailing Address C' Zli <br />Email:� 1 <br />APPLICANT AND/OR PROPERTY OWNER: <br />• Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and prapsrty owner <br />recognize that they are solely responsible for submitting a complete application being aware that upon failure to do so, the <br />staff has no alternative but to reject it until it is complete or to recommend the request for denial of the request regardless <br />of its potential merit. <br />• The Property Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the <br />property by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification <br />of this request <br />• Property Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the Planning <br />Commission and Council_ If an applicant and/or property owner is unable to attend a scheduled meeting, please make <br />arrangements to have an authorized representative attend in place of the applicant/owner and advise the City Planner <br />assigned to your projecL <br />• Information will be distributed bia ail. <br />Applicant Signature: Date: I� lZ' 1 T <br />i <br />Applicant Signature: Date: <br />Property Owner Signature: <br />Property Owner Signature: <br />Vananre AppCcaSon — September 2017 <br />Date: 1 Z.. 1 EcrmiyF <br />Date: _ nE7rg n J <br />Page 4 <br />' L 0 0 C" OF ORONO <br />