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City of Orono <br />Variance Approval Extension <br />Application <br />Street Address: Original <br />2750 Kelley Parkway Variance# <br />Orono, MN 55356 Date <br />Received: <br />Main: 952-249-4600 Staff: <br />I <br />fax: 952-249-4616 1st Extension: $50 <br />Mailing Address: <br />P .O . Box 66 2 nd & 3rd $350 <br />RECEIVED <br />MA R O 8 20 17 <br />CITY OF ORONO <br />Crystal Bay, MN 55323-0066 Extensions: (Counci l approval ) <br />This extension application form must be completed in full and submitted at least 60 days prior expiration date of <br />the variance. In no case shall more than three, one year extensions be granted. <br />Original Variance Number: __ Lt.;;,.._lP_\_3 ________ _ Approval date --'L{~/-'2---~_,_/_zo_l_(p __ _ <br />PROPERTY INFORMATION: <br />Site Address: <br />PROPERTY OWNER INFORMATION: <br />Name: ?~+.c r l--l'V\e.-l1~c-_ 'Sa,~c\..., <br />Phone (primary): (,2S l -30-3 'i'\ 0 [ [p;)\-~'3 --:.79'0 <br />Mailing Address : 2.:z_."2--'tl:e'"'.,,.,ep,'"' A~. <,. --±t-'-lo] <br />City, State&ZIP ~~n~l\s Ml'0 ~l(O/ <br />Email:yttre4c~~tt•,ktsys+--~'.'i-U:n:, / ~5g,-n-l-.r=-1.:i ~ yo.~sy ~ ,. c.ort:) <br />PROPERTY OWNER: <br />• Agrees to pay additional fees (staff time not covered in the original fee payment) and/or consultant expenses incurred in review of <br />this extension application, and <br />• Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner recognize that <br />they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br />but to reject it until it is complete or to recomm end the request for denial of the request regard less of its potential merit . <br />• The Property Owner hereby acknowledges and agrees to this application and furthe r authorizes reasonable entry onto t he pro perty <br />by City Staff, cons ultants, agents, Commission and Council Members for purposes of investigation and verification of this request. <br />• Property Owner acknowledge they must be present at all scheduled review meetings of the City Co uncil. If an applicant a nd /or <br />owner is unable to attend a scheduled meeting, please make arrangements to have an authorized representative attend in place of <br />the applicant/owne r and advise the City Pl a nner assigned to yo ur project. <br />• Informati on will be distributed via email. <br />Property Owner Signature: <:+) ~S ~ <br />Property Owner Signature: '-~~ ~ <br />Variance Approval Extension -J anuary 2017 <br />Date: <br />Date: