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, PC Exhibit A <br /> Ci#y of �rono <br /> Variance Application <br /> StreetAddress: Applicatfon# �D► <br /> �O A SO 2750 Ket{ey Psrkway `� o �3 <br /> 1 V Orono,MIV 55356 Date 12eceived: —/ _/ <br /> Me(n: 9b2-248-4600 ��: <br /> fax 952-249-4616 Fee� �'�(j <br /> 'S 'a +� P.�O.�B xBB�� EsCrow#&$ -- <br /> `° � G� Crystal Bay,MN 55323-Op66 Permit Fee <br /> t�xES HOR�' Nptes: <br /> Please cflmpiete. Applicant wiil be not�ed within 15 days as to the status of the application. <br /> Incamplete applicatlons will n�be placed on Planning Commission Agendas. <br /> SITE LOCATIOiV: 1 i80 Lvma Linda Avenue, Orano, MN 55391 (�$-/�7-�3� 3-v00 a.. <br /> APPUCAPiTIAGENT IfVFQRMA710N: <br /> Applicant Name: Dale Gustafson <br /> Phane(Primary): 763-544-4215 <br /> Applicant Email: �����nk net� --- - <br /> Addr'ess: �1Re1�5 VU�rrnsin As�p Nn City: Cqlden V�Ilev ZlP• 55427 <br /> Applicant is: Contractor Hpmeowner (Circle One) <br /> PROPERTY OWNER IiVFORMATION: ❑check here if property rnnmer is same as applicarrt <br /> Name: Matt Burns <br /> Phone(Primary): 95z-472-9212 <br /> M811111Q Ad��55: 1g66D Azure Road City: p�nhav n ZIP• �91 <br /> Email: matthewmcburn�r(7igma1l nnm <br /> APPUCANT/AGEI�{T AND/OR OWNER: <br /> � . Agree to provide ali lnformatian required or requested by the Planning Department, <br /> � • f�qtee to pay addiBonal fees (staff time not covered in the original f�payrr,ent) andlor wnsultant e�enses incurred In <br /> review oi this spplicatfon,and <br /> � • Certiiy that the informa�an supplled is true and corrsct to the best of hislher la�awledge. TNe appNcant and owner <br /> recognize that thsy ero solety resportslWe tor aubmlttp�g a complete appticatton being aware thet upon fatlure!o <br /> do so,the staff has no aftema#lve but to reject�t uMll It Is compiete or to rec�mmend the requeat for denial ot the <br /> requsst reyardlssa aT lts poterrtlal merEt. <br /> �• Acknowledge the Escrow Agreeme�t is completed and signed. <br /> �r�. Tha Owner fiareby ecknrnMedges and agreee to this applica6on and further authorizes reasonable entry onto the propeRy <br /> by City Stsff,consuttarrts, ager�ts,Commission and Councll Members for purposes of investigation and verification of this <br /> request <br /> ���. Owner and/or Appltcant acknowfedge they must be pteseM at ap scheduled revlew maeUngs oi the Pianning <br /> Commisslon and Council, If an appliqnt andlor owner is unabla to ettend a scheduled meeting, pleese make <br /> arrat�gemen�to have an authorized represerrtative attend in plece of the applicantlowner and advise the City Pianner <br /> assigned to your proJect <br /> ApplicarrtlAgerrt Signature: Date: �ebrua �s,zo�s <br /> Appiicarrt/Agerrt Signature: Date: <br /> � <br /> Property Owner Signature:�� � � �— Date: Z <br /> Property Owner Signature: Date: <br /> Va�fBnce App�Uon-JMuBry 2076 RECEIVE D <br /> Page 2 <br /> FEB � 77h4 � <br /> _ _ __._��_ _�_,._ -- -----. ciN o�oRonfo __ <br /> #� 3 81 ,� <br />