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� City of Orono <br /> ■ . , PC Exhibit A <br /> Variance Application <br /> Street Address: Applicaiion# .� 3 $' <br /> t1 O/�TO 2750 Kelley Parkway — <br /> � � w Orono, MN 55356 Date Received: -� ) <br /> Main: 952-249-4600 Staff: <br /> fax: 952-249-4616 Fee: <br /> � ,� Mailing Address: ESCrow#$$ <br /> � P.O. Box 66 S� <br /> 1 L~ Crystal Bay, MN 55323-0066 Permit Fee <br /> �kFS H��� Notes: <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applications will not be placed on Planning Commission Agendas. <br /> SITE LOCATION: __ q z�� ; Y(�� �. '� �`\� C � O <br /> APPLICANT/AGENT INFORMATION: <br /> Applicant Name: � I� � �C��� <br /> Phone(Primary): - c�C _ � <br /> Applicant EmaiL � -� � ,� -, � .� � ni - � `�� <br /> Address: � �� Cit : � -�p ZIP: `)�� �Q <br /> Applicant is: Cont ctor omeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: �check here if property owner is same as applicant <br /> Name: <br /> Phone (Primary): <br /> Mailing Address: Cit : Z�P. <br /> Email: <br /> APPLICANT/AGENT AND/OR OWNER: <br /> • Agree to provide all information required or requested by the Planning Department, <br /> • Agree to pay additional fees (staff time not covered in the original fee payment) and/or consultant expenses incurred in <br /> review of this application, and <br /> • Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner <br /> recognize that they are solely responsible for submitting a complete application being aware that upon failure to <br /> do so,the staff has no alternative but to reject it until it is complete or to recommend the request for denial of the <br /> request regardless of its potential merit. <br /> • Acknowledge the Escrow Agreement is completed and signed. <br /> • The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property <br /> by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification of this <br /> request. <br /> • Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the Planning <br /> Commission and Council. If a applicant and/or owner is unable to attend a scheduled meeting, please make <br /> arrangements to have an authoriz representative attend in place of the applicanUowner and advise the City Planner <br /> assigned to your project. . <br /> Applicant/Agent Signature: Date: ` /�� � <br /> ApplicanUAgent Signatur�: � ' Date: , <br /> Property Owner Signature: � t Date: // / <br /> Property Owner Signature: ��L--- Date: � l � � <br /> � <br /> Variance Application—January 2016 <br /> � �\� ���� <br /> Page 2 � � � � � , <br /> �(Ii�S��F�� <br />