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� C I� O� O IwO I7 O PC Exhi6it A <br /> � Variance Application <br /> Street Address: Application# � — S 3 `�G <br /> ��� 2750 Keliey Parkway Date Received: �U S G <br /> Orono, MN 55356 Amount Paid: � (.,Q O-O <br /> � 0 Staff: 2 <br /> Main: 952-249-4600 Fee: $600 <br /> � , � fax: 952-249-4616 Renewal: $300 <br /> �t- Gti`S' Mailing Addriess: • After-the-fact: $1,200 Double Fee <br /> �Y,g�o�g,� P.O. Box 66 <br /> Crystal Bay, MN 55323-0066 <br /> This application form must be completed in full. Applicant wiil be not�ed within 15 days as to the status of the <br /> app�ication. Incomplete applications will not be placed on Planning Commission Agendas. <br /> PROPERTY INFORMATION: <br /> Site Address: �a����-�- j�t�1-�- Ctfe� <br /> Property Identification Number (PIN): <br /> (Attach legal description to application if n t included on the survey.) <br /> Date Property Acquired (month/year): 10 �Di � Yes, I�own the adjacent parcels. <br /> Present use of property: '�Residential ❑ Other <br /> Zoning District: <br /> APPLICANT INFORMATIO : (Complete legal names and marital status required for each interested party) <br /> Name: �11 p.l�-�--(1 ,, �}Ja <br /> Phone (home): q�-y,lz-�qs Phone (work): tvtz-y lu�-�pS� <br /> Complete Address: �� (Lesi- Po►n�-C�re,le, Orono, rnN �3by <br /> Email: FT�(�e.nn�ol.Com Fax: "l�-l�ito-�I`I01 <br /> OWNER (NFORMATION: (Complete legal names and marital status required for each interested party) <br /> � Name: <br /> Phone (home): Phone (work): <br /> Complete Address: <br /> Email: Fax. ' ��" <br /> DESCRIPTION OF REQUEST: Estimated Project Cost: $ 5 �90C� � <br /> Describe the request in detail (attach additional sheets if necessary): . <br /> � re- s h o , S� , <br />