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• `j p�� � <br /> . 1.1L�/ OT V('Of10 <br /> Variance Appiication PC ExhibitA <br /> Street Add�ss: Application# � �jgL�. -�j <br /> �O/�jO 2750 Keiley Paricway <br /> j r Orono,MN 55356 Date Received: <br /> Main: 952-249-4600 <br /> Staff: <br /> fax: 952-249-4616 Fee: b0� <br /> � Mailing Address: �. <br /> �� �� P.O.Box 66 Escrow#&$ <br /> 1 G Crystal Bay,MN 55323-0066 Permit Fee <br /> qkFs H�4� 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 Agenda. <br /> SITE LOCATION: _ I � VI � -A��C)� �� <br /> DESCRPTION OF REQUEST: ��I�LC�LV�G�� — ���'�C�l l�/1G�'�1t �j e'I���-�$ <br /> fattached additional sheets as necessary) <br /> APPLICANT/AGENT INFORMATION: <br /> Applicant Name: "�'"� M �(� k <br /> Phone (Primary): _���^�^�_��—� t� <br /> Applicant Email: , <br /> Address: �-I 2 Z�SZ ► �S � + �� c�tv� t�. a�v� ziP� ���� g <br /> Applicant is: Contractor Homeowner (Circle One) r <br /> PROPERTY OWNER INFORM TI N: ❑ check here if property owner is same as applicant <br /> Name: <br /> Phone(Primary): <br /> Mailing Address: �` Ci : 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 consuftant expenses incurred in <br /> review of this application, and <br /> • Certify that the information supplied is true and co►rect to the best of his/her knowledge. The applicar�t 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 altemative 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 inves#igation 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 an applicant and/or owner is unable to attend a scheduled meeting, please make <br /> arrangements to have an authorized representative attend in place of the applicanUowner and advise the City Planner <br /> assigned to your projed. <br /> ApplicanUAgent Signature: Date: �� Wv� � � ��, � <br /> Applicant/Agent Signature: Date: <br /> Property Owner Signature: Date: ��� ��� <br /> Property Owner Signature: Date: <br /> Variance Application-May 2016 <br /> Page2 JUN 2 1 2Q1R <br /> '� � $ � � � CITY OF ORONO <br />