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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 . Box66 <br />Crystal Bay, MN 55323-0066 <br />Application # <br />Date Received: <br />Staff : <br />Fee : <br />Escrow: <br />Notes : <br />APPLICANT INFORMATl~N: 0 check hpre if Applicant address should be used for billing <br />Applicant: ~Y\!llW~ vJ,~i <br />Phone (Primary): q1 9 -':i '-1 ~ ...f~ <br />Mailing Address: -z. ,st . w Q ~h.b _lbi.i!'l =, City: Gvc,\c,/ r:· ZIP: 5 .£D r <br />Email : Su.1 ~tL.~.:--'~~,_11 ..... h'--'-< ..... iJ ..... h\c.ic.\----·------------------ <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 />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 autho r izes 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 ackn ctledge they must be present at all scheduled review meetings of the Planning <br />Commission and Council. If an appli c/nt and/or prope y owner is unable to attend a sch eduled meeting , please make <br />arrangements to have an authorized epresentative end in place of the appl icant/owner and advise the City Planner <br />assigned to your project . <br />Information will be d istributed <br />Applicant Signature: <br />Applicant Signatu re : Date: <br />Property Owner Signature : Date: <br />Property Owner Signature: Date: RECEIVED <br />Variance Application -January 2017 <br />Page4 SEP 2 0 Z01 I <br />:r 3 9 80 CITY OF ORONO