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City of Orono Variance Application Street Address: 2750 Kelley Parkway Orono, MN 55356 Main : 952-24!M800 fax: 952-24~16 Mailing Addnlss: P .O. Box66 Crystal Bay, MN 55323-0066 Application # Date Rece ived Staff Fee Escrow#&$ Permit Fee Notes Please complete. Applicant will be notified within 15 days as to the status of the application. Incomplete applications will !!2! be placed on Planning Commission Agenda. SITE LOCATION: DESCRPTION OF REQUEST: $.\ • &lh b, fl,-9t"¢'½3 {fk»s p,\}f>bkcl-) (attached additional sheets as necessary) APPLICANT/ AGENT INFORMATION: Applicant Name: A'«ic ~ , P-~,..,,o...._ LLl- Phone (Primary): _,"'""s""'z.=--c.=9 .... 1~-"'--'~'--9 __________________ _ Applicant Email: o-lc,x ~ I:tWiSitk ,.., ... ,t..,:r,,,.. Address: ~.., Lc...',tc. '\'\-t City: W~:z,...Jo,, A pplicant is: Co~or Homeowner (Cir c le O ne) ZIP: S 1fH1 PROPERTY OWNER INFORMATION: D check here if property owner is same as applicant Name: Iixn,~ "" S11l\'lllf>.b .... ._~ Aw-.~ \<. <;~n, ... ...,. Phone (Primary): Mailing Address: Lft.to e,""'..... n $ City: otR()p ZIP : 55~'!11 Email: APPLICANT/AGENT AND/OR OWNER: • Agree to provide all Information required or requested by the Planning Department, • Agree to pay additional fees (staff time not covered in the original fee payment) and/or consultant expenses incurred in review of this application, and • Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner recognize that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no altematlve but to reject It until it Is complete or to recommend the request for denial of the request regardlGN of Its potential meril • Acknowledge the Esaow Agreement is completed and signed . • The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property by City Staff, consultants, agents, Comm ission and Council Members for purposes of investigation and verification of this request. • Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the Planning Comm ission and Council. If an applicant and/or owner is unable to attend a scheduled meeting , please make arrangements to have an authorized representative attend in place of the applicant/owner and advise the City Planner assigned to your project. Applicant/Agent Signature: ~~~"'"""""=e~.,,.,c;..::.,.=~------0,ate: g/2.'1/\r. Applicant/Agent Signature: Property Owner Signature : -~---~--,t"---_____ Date: _ 1 _S-_S~---Zt)-/_t,_ __ _ ---.~'--/o+.'--....,,,..,.C..------0 ate: 7RECEIVED Property Owner Signature: _______________ Date: SEP 2 1 2016 V8fisnce Application -Msy 2016 Page 2 CITY OF ORONO