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� � � C i ty of O ro n o �'C �xhibit A <br /> Variance Application <br /> "�, 2 50 e�ey arlcway APP���n# �. �, g <br /> >���0 Orono,MN 5b356 Date Recefved: <br /> Maln: 952-249-46pp StBff: �� ' -- <br /> iax: 952-24&461 B Fee: �'!�L�� <br /> ,�! '' MeilltJg AddreSS: —�'wa <br /> ''��, _ ,�` P.O.8ox 88 Escrow#8�$ <br /> G Crystel Bay,MN 55323-006fi Permit FL6 <br /> �'�F5 H�'�4' Notes: <br /> Piease complste. Applicant will be not€�ed within 15 days as to the status of the application. <br /> Incomplete applications will not be placed on P{anning Ccmmission A,ge�das. <br /> SITE LOCATION: '"i k D �.t� i4ta-vt� <br /> APPLiCANT/AGENT INFORMATION: .r � <br /> Applicant Name: u� � <br /> Phone (Primary}: �Z, • �-�. <br /> Applicant Ematl: �„t ��„G. , � <br /> Address: �. a Gli ZIP: ��I <br /> Applicant is: Contractor Homeowner ( irc e Orte} � ZOb CI .M�N <br /> PROPERTY OWNER INFORMATIONi ❑ check here ff property owner is same as applicant <br /> Name: GN R.1 S =, l,�S�-�E � <br /> Phone {Prlmary): Z , n , � a <br /> MaEiing Address: �o �.T� - � C' � Z�p: <br /> Ema{I: ,� �, <br /> APPLECANT/AGEN7 ANG/OR OWN�R: <br /> • qqree to provide aU infom�ation required or requested by the PEanning Department, <br /> • �qree to pay additiona! fses (s#aff time not oovered In the origina! fee paymerrt) artd/or cansuttant expenses incurred in <br /> review of this appiiqtion,and <br /> • Certify that the information supplied is tn�e and correct to the best of hls/her knowledge. The applicarrt and owner <br /> reco9nize that they are solely responsible#or submltting a comp(ete appl{catlan being awars that upon failure to <br /> do so,tlte stafF has no alternative but to reject it unttt it Is camptete or to recommend the request for denial of the <br /> request regardless af fts potential merit. <br /> • Acknowledge the Escrow qgreement is campleted and signed. <br /> • The Owner hereby acknowledgss and agrees to this application and turthsr avthorizss reasonable entry onto the property <br /> by City Staff,consuttants, agents, Commfssion and Coundl Members for purposes of Investigaiion and veriTicatlon of this <br /> request <br /> • Owner andlor Appllcant acknowtedge they must be present at atl schet4uled revlew meetings of the Planning <br /> Commisslon and Councit. If an applicarrt and/or owner is unabie to attend a scheduled meeting, �lease make <br /> srrangements to have an authorized representative attend In place of the applicarrt/owner and advlse the City Planner <br /> assigned to your proje <br /> , <br /> Applic�nUAgent Signa#ure: , Date: '7 �t/� �� <br /> ApplicantlAgent Signature: Date: <br /> Property Owner Signature: pate: �?�t s f 1� <br /> Property Owner Signature: Date: <br /> VarFsnce Applk�rrtbn—r8nua,y�o�s MAR 15 2016 <br /> Pege 2 <br /> # 3 8 �. � ���oR� <br />