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4 I . <br /> ' � ' � PC Exhibit A <br /> . . RECElV�D , <br /> �uG � :� 2oos C ity of� O ro n o <br /> �iTY C�F �FtA[�O .Va ri a n ce A.p p I i cati o n <br /> � � �- StreetAddress: � Application# �� <br /> ,�`�u�' � 2750 Kelley Parkway � Date Received: •Q <br /> , O�� '`VO .Orono,�MN 55356 . ,--� <br /> Staff: . G 1 <br /> � � . � Main: 952-249-4600 � � � Fee: $600 <br /> � � �+ fax: 952-249-4616 � � Renewal: $250 ' � <br /> � �� �,ti`y Mailing Address: After-the-fiact: $1,200 Double Fee <br /> ��'ESxo�``'� P.O. Box 66 . . Escrow Fee: $600/$2,500 .� <br /> . Crystal Bay, MN 55323-0066 � . , N� �.U�P� <br /> .� <br /> � <br /> This application form must be completed in full. Applicant�will be notified within 15 days as to the status of the � <br /> application. lncomplete applications will not be placed on�Planning Commission Agendas. <br /> PROPERTY INFORMATION• .. . ' . <br /> Site Address: � % �(7 �/P,�f v,`-e.�/ ��� � Q�h J �yj�v �S�7 S I�, � <br /> Property.ldentification Number(P.IN): . <br /> � Date Property Acquired (month%year): ' ❑ Yes; I own the adjacent parcels. . • <br /> Zoning District: _ � ]Z - � /.� � . � - '� � <br /> APPLICANT INFOR TION: (Com lete legal�.?a�;,}es and marital status required for each interested party) <br /> Name:� � � � ,ut� -(Pa� i� . . <br /> Phone (home):� (� - �f - 1,5� 1 Phone (work): "��,, � -�/"77 ". S �,� <br /> Complete Address: � Cj0 . P fl/i 1'�J "r/-� <br /> City, State & ZIP rc n v , /Y�N �� lo <br /> Email: � .�Ce�1=�- ho�h.C�t�d[.� ra� I�ehn�.�'• �w• Fax: _�7(n. � -� Y7 7 —� �,Syc� <br /> � OWNER INFORMATION: (Complete legal names and marital status r�quired for each interested party) � <br /> Name: � �� . �� <br /> Phone(home): � � ��T. Phone�(work): . � <br /> Complete Address: <br /> City, State & ZIP � <br /> Email: . Fax: � <br /> DESCRIPTION OF REQUEST: <br /> Describe the request in detail (attach additional sheets if necessary): � �,{J�,y�-� � ,:�Ca-�� <br /> I d�2 `�1�. �l,�.i'�O.�iD� C:�.-vl(,� Cci�CQ �� �1�p i PGrOU.� Gc � e�- �• � �rt <br /> h67t�, i/�fnlbv�v�'r��� a�� hDU,I� �Ic� �Q' 1t) ni�4 i'r�2 �' , cic�l�-�,�' � �f s 1"Gt{'1 -C.�OkF� /�a.� <br /> � � �c�nG�C��- � cti,;� o�; S�a//� c�i �elc�' ����'�c.��� �o� f��a�'�ti � �/� �or�a� �i� a��u�cy �t <br /> .. � f .Z� ��ba fos �'ov�r/�a� 9�v�a�,r �z'ao;� rf �or;��- -lf�t� �e n�7` {u�c� fdn o�� <br /> �' � �T <br /> V <br /> --�� � /�. � f t��G U Ct �`� a �0 m a// L/-adFQJ�v� Scc���« C!ov,�� lJc�7��C f v <br /> l n(` PQ ,�yi ��v,� � , `�It,e. f1 G�r� i� Ccr�rerr�l� t+,� l ~ �.Sf-� � �/ . mc- / <br /> CZ�� I c��n _ •f � Ic�t �'�' �.v h�tuClt �2U;cl� inr' c�� - rn �-4� - (eck� Q e f�w cc�vR;i�'�, <br /> 0 <br /> ' -14- <br />