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� � .� , � PC Exhibit A • <br /> City of Orono <br /> Variance Application <br /> Street Address: Appiication# ���' �_t 1 � <br /> ��� 2750 Kelley��Parkway Date Received: ('��/��q� <br /> Orono, MN 55356 <br /> 0 � . Staff: G� . <br /> Main: 952-249-4600 Fee: $ 0 <br /> � � �+ fax: 952-249-4616 Renewa. $350 <br /> ��,c, �ti MailingAddress: After-the-fact: $1,40 ble Fee <br /> �`�kEsxo�'� Crystal Bay, MN 55323-0066 Escrow Fee: $600 2,500 <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 appiications v►iill not�be placed on Planning Commission Agetidas. <br /> PROPERTY INFORMATION: ` <br /> Slte Addl'eSS: 1095 Ferndale Road W. <br /> Property Identification Number (PIN): " 02-117-23-4.3-0023 <br /> Date Property Acquired (month/year): �5 'T S"" ❑ Yes, I own the adjacent parcels. <br /> Zoning District: Lx-IA <br /> APPLICANT INFORMATION: (Complete legal names and marital status required for each interested party) <br /> Name: i�'�i � ��-`Y <br /> Phone (home): �.t�J`�f �6 /�J �j Phone (work): % _ � �'���r,/ �G' <br /> Complete AddreSS: 440 Ferndale Road W. � <br /> City, State & ZIP Wa zata, MN 55391 <br /> Email: �Fv i� [��,T�-��tij, C�+f� °� Fax: -� , ' ' i,? ,�yi �`� <br /> OINNER INFORMATION: (Complete legal names and ma�ifal status required for each interested party) � <br /> ., <br /> Name: � L /� �� �v r�- I�=Cr 5���.�� � <br /> Phone (home): C,� <'„���`���f� ; _/� Phone (work): 1l/�� <br /> Complete Add�ess: 1095 Ferndale Road W. <br /> Clty, State & ZIP Wa zata, NII�T 55391 <br /> Email: �/�/� Fax: 11� <br /> DESCRIPTION OF REQUEST: <br /> Describe the request in detail (attach additional sheets if necessary): . <br /> WP are requesting a Lakeshore Setback Variance, Hardc�v�r Variance, and a <br /> Floodplain Conditional Use Permit for our proposed new residence at <br /> 1095 Ferndale Road West. <br /> - 14 - <br />