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City of Orono <br />Variance Application <br />Street Address: <br />2750 Kelley Parkway <br />Orono , MN 55356 <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 />Application # <br />Date Received : <br />Staff : <br />Fee: <br />Escrow: <br />Notes: <br />$700 <br />$700 I $2,500 <br />PC <br />Exhibit A <br />#17-3980 <br />APPLICANT INFORMATIQN: D check hf!re if Applicant address should be used for billing <br />Applicant: 5 Y\OMI!'.\ vJ t sJ,vvi<. if <br />Phone (Primary): 9)'! -~'1 i -ii~ <br />Maili~gAddress: 'Z.$Sl w1gtbh /bu~ .~' City : 6-V"l\t./l ZIP: $5:12/ __ _ <br />Email: 5v.J ,s 4'..:nt4 t~-~=i/---"--~'1,_,1 ..... · .. ........__c .... cJ ..... &:i~------------------- <br />PROPERTY OWNER INFORMATION: Zcheck here if Property Owner is same as applicant <br />D check here if Property Owner address should be used for billing <br />Name: <br />Phone (Primary}: <br />Mailing Address : Cit: ZIP: <br />Email: <br />APPLICANT AND/OR PROPERTY OWNER: <br />• <br />• <br />• <br />• <br />Certify that the information supplied is true and correct to the best of his/her knowledge . The applicant and property 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 ack~ledge they must be present at all scheduled review meetings of the Planning <br />Commission and Council. If an appli nt and/or prope y owner Is unable to attend a scheduled meeting, please make <br />arrangements to have an authorized' epresentative end in place of the applicant/owner and advise the City Planner <br />assigned to your project . <br />Information will be distributed <br />Applicant Signature: <br />Applicant Signature: <br />Property Owner Signature: <br />Property Owner Signature: <br />Variance Application -January 2017 <br />Page4 <br />Date: <br />Date: ------------ <br />Date: