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<br /> , Variance Application
<br /> Sfreet Address: Application# QJ' �15�
<br /> �O� 2750 Kelley Parkway Date Received: J`'j
<br /> Orono, MN 55356 Amount Paid:
<br /> O ,c O staff: ,Ikl iC-C-
<br /> ����;;, Main: 952-249-4600 Fee: �600
<br /> �;� ,�`� � fax: 952-249-4616 Renewal: $300
<br /> � �'' �,;�
<br /> �� '' ��1 G~� Mailing Address: , After-the-fact: $1,200 Double Fee
<br /> l ti P.O. Box 66
<br /> 9kESH�g Crystal Bay, MN 5532�-0066
<br /> _ ___.._. . ___ . _.
<br /> __ .._...__.._ ..
<br /> This application form must be completed in full. ApF.;cant wili be notified within 15 days as to the status of the
<br /> application. Incomplete applications will not be placed on Planning Commission Agendas.
<br /> PROPERTY INFORMATION:
<br /> Site Address: ��(pQ �/�(�,�(L � (.�L.�S (ZI�
<br /> Property Identification Number (PIN): 03-. � 17 - Z3 - 3`I- 0009
<br /> (Attach legal description to application if not included on the survey.)
<br /> Date Property Acquired (month/year): ��� ❑ Yes, I own the adjacent parcels.
<br /> Present use of property: E�I Residential ❑ Other
<br /> Zoning District: �
<br /> APPLICANT INFORMATION: (Complete legal n2�:.�s and marital status required for each interested party)
<br /> Name: ,d ' ���'!
<br /> Phone (home): • • Phone (work): �(� �L�- � ��09� �
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<br /> Address: '� �' E,.� e • ��' �
<br /> Email: �i � o . cJcc�� � Fax: ,
<br /> ��,��a_n� � � a (
<br /> OWNER INFORMATION: (Complete legal names �-d marital status required for each interested party)
<br /> Name: � �, N M,OOS
<br /> Phone (home): q SZ•�7(o-j�► 8 5 Phone (work): q S Z - -��f 2- y�y 7 y
<br /> Address: �1�� ��,g� t-{��,5 R,O
<br /> Email: Sp�,ra_�MO o S@ Ga-r�;11.co Y►-, Fax:
<br /> DESCRIPTION OF'R�I�QUEST: � � � Estimated Project Cost: $ �;.�:��', <��-.�.-��
<br /> Describe the request in detail (attach additional sheets if necessary): �
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