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City of Orono Variance Application Street Address : App li cation # 18-3997 2750 Kelley Pa rkway Oro no . MN 55356 Date Received : 12 13 17 Mai n: 952-249-4600 Staff : MC fax : 952-249 -4616 Fee : 700 Mailing Address : P .O. Box 66 Escrow: $700 Crystal Bay , MN 55323-0066 Notes : PC Exhibit A #18-3997 Please complete . Applicant w ill be notified within 15 days as to the status of the application. Incomplete applications will not be placed on Planning Commission Agenda. SITE LOCATION: \ "10 0 ~lIS fol"[( l!,C>AP 1 41?-<?r:Jo M,H, ,5'?,t:f I DESCRIPTION OF REQUEST: _.;:6c.cF:.:,:;li-;;...c.;A._.lS7n(""""'_.M~m2"'"""'------------------- (attach additional sheets as necessary) APPLICANT INFORMATION: D check here if Applicant address should be used for billing Applicant: ,\EAN l?:Et\!Y,,,Me k:AA,,$4'N Phone (P rim ary): 61l.. Z S5" ,1'2.. 7 5' Mailin g Address : '27~'1. WSf.T =43 ir-o ST City: Mfl.,2 ZIP : S: G t.f Io Email : ...lf;.t\r:l <"< 12.Et:\14:AMfkAt?.SorJ . co)'\ PROPERTY OWNER INFORMATION: D check here if Property Owner is same as applicant Ji{ check here if Property Owner address should be used for billi ng Name : Phone (Primary): Mailing Address: City: 012.n ,.J,o ZIP : 1:7 IS", 't l Email : APPLICANT AND/OR PROPERTY OWNER: • Certify that the information supplied is true and co rrect to the best of his/her knowledge . The applicant and property owne r recognize that they are sole ly responsible for subm itt ing a complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete or to reco mm end the request for denial of t he request regardless of its potential merit . • The Property Owner hereby acknowledges and agrees to this app lication and further authorizes reasonable entry onto the property by City Staff , consu ltants, agents, Comm ission and Counc il Members for purposes of in vestigation and verificat ion of th is request. • Property Owner and/o r Applicant acknowledge they must be pres ent at all schedu led review meetings of the Planning Commission and Council. If an applicant and/or property owner is un able to attend a scheduled meeting , please make arrangements to have an authorized representative attend in place of the appl ican t/owner and adv ise the City Planner assigned to your project. • App licant S ignature : Date : App licant S ignature : Date : Date : / Z · f 3 ·It= Property Owne r Signature : Date : Varian ce Applic ation -Janua ry 2017 Page4