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ti � <br /> +� F~ PC Exhibit A <br /> C i ty of O ro n o <br /> Variance Application <br /> Street Address: Application# U'�f-3 y� � <br /> ,�`�� 2750 Kelley Parkway Date Received: �- �� <br /> Y Orono, MN 55356 <br /> � ' Q ' Staff. � <br /> Main: 952-249-4600 Fee: � <br /> � �+ fax: 952-249-4616 Renewa. <br /> ��t Gti`�` Mailing Address: After-the-fact: $1,200 Double Fee <br /> 9kESH�g'� P.O. Box 66 Escrow Fee: $600/ ,50 <br /> Crystal Bay, MN 55323-0066 , <br /> This application form must be completed in full. Applicant will 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: �80 Ferndale Road W. <br /> Property Identification Number(PIN): 02-117-23-44-0029 <br /> Date Property Acquired (month/year): 09/2006 ❑ Yes, I own the adjacent parcels. , <br /> Zoning District: LR-IA � <br /> APPLICANT INFORMATION: (Complete legal names and marital status required for each interested party) <br /> Name: Jack W. Safar <br /> Phone (home): 952-471-8468 Phone (work): 763-354-5624 � <br /> Complete Address: 980 Ferndale Road W. <br /> City, State &ZIP Wayzata, MN 55391 <br /> Email: gg;POrge@mch�i.com Fax: 952-471-9494 � <br /> OWNER INFORMATION: (Complete legal names and marital status required for each interested party) <br /> Name: Jack W. Safar. <br /> Phone (home): 952-471-8468 Phone (work): 763-354-5624 <br /> Complete Address: 980 Ferndale Road W. <br /> City, State &ZIP Wayzata, MN 55391 <br /> Email: p�eorge@mchsi.com FBx: 952-471-9494 <br /> DESCRIPTION OF REQUEST: . � � <br /> Describe the request in detail (attach additional sheets if necessary): <br /> We are askin� for a Lakeshore Setback, Hardcover within 75' Variance to add a <br /> laundry room and pantry to our existing residence. See enclosed Hardship Statement. <br /> - 14- <br />