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� City of Orono <br /> ■ ■ ■ PC Exhibit q <br /> Variance Appiication <br /> �� Streef Address: Appllc�tion# � " �, <br /> 2750 Kelley Patkway 4�� <br /> O Orono,MN 55356 DBte ReCeived: <br /> Maln: 952-249-4600 Steff: � G <br /> fax 952-249-4616 Fee: ''� <br /> .1 � � Melling Add�as: I Escrow#8� 6v <br /> � ' � P.O.Box 66 $ <br /> �l � L~ Crystal Bay,MN 55323-0066 Perm�t�ee <br /> �x�s H°�� Notes: <br /> Please oamplete. Applicant will be not�ed within 15 days as to the status of the app�ication. <br /> Incomplete applications will not be plac d on Planning Commission Agendas. <br /> SITE LOCATION: 1 .�lt 7. !�3 -�,7? <br /> APPLICANT/AGENT INFORMATION: <br /> Applicant Name: <br /> Phone{Primary}: <br /> Applicant Email: <br /> Address: <br /> AppRicant is: Cantrac#or eowner Cit : Z�p. <br /> (Circle One) <br /> PROPERTY C}W ER INFORMATION: ❑ check here if prope owner is same as applicant <br /> Name: y�.,; • � �L� <br /> Phone(Primary}: -� <br /> Mailing Address: -7 Cit : � (s�-�ZIP: �. <br /> Email: <br /> APPLICANT/AGENT AND/OR OWNER: <br /> • Agrae to provide all Informatbn required or requested by ihe Planning Departmerrt, <br /> � Agree to pay addltiona! fees (staff time not covered in the original f6e payment}and/or consultant e�enses incurred tn <br /> review of this applicatbn,and <br /> • Certify that the information supplied is true and correct to the best af h{sJher know{edge. The appilcant and wvrser <br /> rscognlze that they are solefy respons;ble for submltttng a complete appllcation being aware that upon fatlure to <br /> do so,the s#aft has no altemative but to reject it untt!it is complete or to rscommend the request for denlal of the <br /> request regardless of Its potenttal merft. <br /> • Ackriowledge the Escrow qgreemerit is completed and signed. <br /> • The Owraer hereby acknowledges and agrees to this applicatlon and further authorizes reasonable entry onto the properly <br /> by City Staff,consuttants, agents, Commission and Councll Members for purposes of investigatlon and veriflcation of this <br /> request. <br /> � Owner andlor Applicant adcnowledge they must be present at all scheduled revfew meetings of the Planning <br /> Commission and Cauncif. If an applicanf and/or owner is unable to attend a schedu[ed meeting, please make <br /> arrangements to have an authorized representative attend in place af the appGcanUowner and advlse the City Planner <br /> assigned to your proJect. <br /> ApplicanUAgent Signature: Date: <br /> ApplicanUAgent Signature: Da#e: <br /> Property �wner Signature: Date: � � j� — � <br /> Property Owner Signatur Date: <br /> Varianca Applkx�tion—Janerary 2016 F G u I 0 ���6 <br /> �2 # 3 81 � � ��n o�o�oNo <br />