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� PC ExhibitA <br /> City of Orono <br /> Variance Application <br /> streer Address: ApAlica#ion# �r' '�$�3GJ <br /> ��O A TO 2750 Kelley Parkway <br /> 1�� Orono, MN 55356 D8t8 ReCelv6d: Q <br /> y o, Mein: 952-248-4600 S��: <br /> tax: ss2•2�g-ae�s I Fee: � �IC. f 2-�sJ ; <br /> ,,� � - MalRng Addr�ss: Escrow#�S ���� �a( C f C_.. 1 Z g f(�, <br /> � 1 +� P.O.Box 66 <br /> �' G� Crystal Bay,MN 55323-0066 Permit Fee <br /> t�XPs�0�� Notes: <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> incompfete applications will n„c�t be placed on Planning Commission Agendas. <br /> SITE LOCATION: I r7 9� r�1�►-�.�SS' P�F.---�- Iw�l <br /> 0 <br /> DESCRPTION OF REQUEST: C�a-Kq�- �'o o� pv-�. �no„�,"� S <br /> {a#tached addi�U'anal sheets as necessary} � � <br /> APPLiCANT 1 AGENT iNFORMATION: <br /> Applicant Name: _��1lrc�.a-e.� r�s.-�lus �ksf �-�-� <br /> Phone(Primary): �-�oq- 979� � �' <br /> Appficant Email: ar�. �����-s � 4 N.a c ti,c�� <br /> Address: 63oj ���,. ,4...��— City: ��(� Z�p� .�s3t.s� <br /> Applicant is: n ra Homeowner {Circle One) � <br /> PROPERTY OWNER INFORMATION: ❑ check here If property owner is same as applicant <br /> Name: ��,.� a�t� l;,.-�-..-� <br /> Phone(Primary): 's�- a� _ ,�' ' <br /> Mailing Address: /q9� �P,.,,,s�s a,z•.�- Gity: O�-�c.,u ZIP: <br /> Email: <br /> APPLICANTIAGENT AND/QR OWNER: <br /> . Agree to provide all lnformatbn required or requesteci by the Ptanning Department, <br /> • Agree to pay add'stional fees (staff tlme not covered in the orfginal fee paymer�t)and/or consul#ant expenses incurred tn <br /> review of thls appllcation,end <br /> • Certify tfiat the information supplfed Is true and correct to the best of hiaJher knowledge. The applicant sed owner <br /> recognlze that they are solely rospor�slble for aubmitting a complete appllcatlon bsing aware that upon fallure to <br /> do so,tha staff ha�no altemative but to reJect it untit it is complete or to rocommend the roquest for denial of ths <br /> requsst rogardless of Ita potentlal merit <br /> . Acknow{edge the Es�row AgreemeM Is completed and slgned. <br /> . The Owner hereby acknaw{edges and agress to this applicetion and further authorizes reasonable eMry onto the p�perty <br /> by Cfty Statf,consuttsrrts,agents,Commisslon and Councif Members for purposes of investigadon and veriflcstion of this <br /> request. <br /> • Owner andlor Appllcant acknowledse they must be pre�eent at all scheduled reWew meetings af the Planning <br /> Commission and Council. If an applicant encUor owner is unable to attend a scheduled meeting, ptease make <br /> arrangements to have an authorized re tive attend in pface of the applicantlowner and advlse the Cit�r Planner <br /> asslgned to your proJed. <br /> ANrlicanUAgent Signature: Date: SJ �� Z G/� <br /> ApplicanUAgent Signature: Date: <br /> Property Owner Signature: ��,�„u�'" " Date: a <br /> Property Owner Signature: Date: �E�,��VEa <br /> v�n�►,�a��r�r;on-,�rri�o1s �lAY 1 8 201 fi <br /> Page 2 '` � � � r <br /> � 1% <br /> ctnr oF oRorvo <br />