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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 />Cryatal Bay, MN 55323-0066 <br />Application # <br />Date Received <br />Staff <br />Fee <br />Escrow#&$ <br />Permit Fee <br />Notes <br />. Please complete. Applicant will be notified within 15 days as to the status of the application. <br />Incomplete applications will !!2! be placed on Planning Commission Agenda. <br />SITE LOCATION: <br />DESCRPTIO N OF REQUEST: AA e, b \y h, ~t2f1:!lg {9km 4\\f>bk«!-) <br />(attached additional sheets as necessary) <br />APPLI CANT / AG ENT I NFO RMATI ON: <br />Applicant ~ame: A» ¼ , @.q,v\.-.19"' LLC.. <br />Phone (Pnmary): _,.t.:.s~2..'""'-~u<>w.1...J·"..,_t:i..:::.9;:__ ________________ _ <br />Applicant Email: p.,}s 4 @, i:wiSi°"""'"' ·"°"" <br />Address: .z:s:,."' L~'«. ... , t City: W~!o. <br />Applicant is: Co~tor Homeowner (Circle One) <br />ZIP: 55191 <br />PROPERTY OWNER INFORMATION: □ check here if property owner is same as applicant <br />Name; Ttmo~~ M S1il\;v6'h ... --~ AM~ \<. ~•1h••"' <br />Phone (Primary): <br />Mailing Address: "4o a,...,.... u. s City: Oto00 ZIP: 55 ~', <br />Email: <br />APP LICANT/AGENT AND/O R OWN ER: <br />• • <br />Agree to provide all lnfonnation required or requested by the Planning Department, <br />Agree to pay additional fees (staff time not covered in the original fee payment) and/or consultant expenses incurred in <br />review of this application, and <br />Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner <br />recognize that they are eolely responsible for eubmltting a complete appllcatlon being aware that upon failure to <br />do s o, the staff has no alternative but to reject It until it Is complete or to recommend the request for denial of the <br />requnt regardleee of 118 potential merit. <br />• <br />• <br />• <br />• <br />Acknowledge the E&a'OW Agreement is completed and signed . <br />The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property <br />by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification of this <br />request. <br />Owner and/or Appllcant acknowledge they must be present at all echeduled review meetings of the Planning <br />Commlsalon and Council. If an applicant and/or 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 project. <br />Applicant/Agent Signature: u~=~=<:;i!;~;...:=:::,,,=::;;,,..,,::.._ _____ ,Date: K/2.'1 /lr, <br />Applicant/Agent Signature: <br />Property Owner Signature: <br />-~---...-..r.--eo ______ Date: _ <br />1 <br />_S""'_S_~--'2,,o-/_l.... __ _ <br />-~~~'-1,,,l-_______ Date: --------'l'{"li,Jl;E..4C""'IE~1f\ojv-eo <br />Property Owner Signature: ______________ Date: <br />SEP 2 1 2016 <br />Variance Application -May 2016 <br />Page2 CllY OF ORONO