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PC ExhibitA <br /> �ity of Orono <br /> Variance Application <br /> Sb�eetAddress: qpplication# <br /> ��O A rO 2750 Keltey Parkway <br /> {�� Orono,A+il�55358 DRte Reoelved: <br /> �C. . <br /> -1 Main: 852-249-4640 ��: <br /> fax: 952-249-4816 FBe: /r' d C�L �D� � <br /> �, MstNr�Addness: ���W#�$ <br /> � � P.O.Box 66 '�"� ^ <br /> � G~ Crystal Bay,MN 55323-0066 Petmit Fee <br /> ���ESHa�� I Notes: <br /> Please complete. Applicant witl be notified within 15 days as to the status of the appfica#ion. <br /> tncomplete appllcations wltt not be placed on Planning Commission Agendas. <br /> SITE LOCATION: ��G� ���(�a.�C� L-.-%�Cl�lG�`l1� ���.C'�� <br /> ! , <br /> DESCRPTION OF REQUEST: �i^��Ft <"��".At�" ��''," ^�rl�' f � ��- '� �� ;v�� ' jf c�:{ !"•* %- <br /> ; 1°�i t ...�CY..r si'1 S�! l��l^'r�`�Lti f c.�'': <br /> (attached additiorial sheets as necessary) <br /> APPLICANT 1 AGENT INFORM TION: <br /> Appllcant Name: J =F' A G�,O <br /> Phone(Primary): '$ —5� Gp <br /> APP��cant Email: R Cc9�t1 , e <br /> AddreSs: �f� 9d �0 k �fe+� ,{lor CitY�J�J�'� �r�!i�. ZIP' '�s �// <br /> Applicant is: Contractor Homeowner {Circle One) <br /> PROPERTY OWNER II�lFORMATION: Qd'check here if property owner is same as applicant <br /> IVame: <br /> Phone(Primary}: <br /> Meiling Address: City: ZIP• <br /> Email: � <br /> APPLICANTIAGENT ANDIOR OWNER: <br /> • Agree to provide ali informat�on requtred or requested by the Planning Departrnent, <br /> . Agree io pay addiiional fees (staf�time not oovered in the original fee payment)and/or consultant e�enses incurred in <br /> revPew of this applicatlon,and <br /> • Certlfy that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner <br /> recogt►Ize that they are solely responslble for submittinp a compiete applicatfon being aware that upan failuro to <br /> do so,the staff haa no alternetive but to reject it untit it is complete or to recommend the rcqusst for denlal of the <br /> request reyardless of ib poteritial merft. <br /> • Acknowledge the Escrow Agreement is oompleted and signed. <br /> • The Owner hereby acknowledges and agrees to th�s application and further authorfzes reasonable errtry onto the property <br /> by City Staff,wnsultants, agents,Commission and Councll Members for purposes of EnvesUgation and veMfication of this <br /> request. <br /> • Owner andlor Appllcant acknowledge they must be present at all achaduled revlew mestings of the Planning <br /> Commiss(on and Councll. 1f an applicant andlor ommer is unable to attend a scheduled mestlrtg, p(ease make <br /> errangements to have an authorized represerrtative atfend in place of the app{IcanUowner and edvise the City Planner <br /> assigned to your project. <br /> Appllcant/Agent Signature: Date: <br /> Applicant/Ageni Signature: Date: <br /> Property Owner Signature: Date: <br /> Property Owner Signature� Date: j�►FrC�t�Cn <br /> VarJance App!lcetlon—Apd!201fi <br /> ��2 MAY 1 8 2016 <br /> � '� � �7 CITY OF OROAIQ <br />