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Ci ty of O ro n a PC Exhibit A <br /> Variance Appiicatian <br /> Street Address: Application# �L�(� <br /> �O/� rO 2750 Kelley Parkway <br /> � �� Orono,MN 55356 Date Received: 2.2% <br /> Staff: �(� <br /> Main: 952-249-4600 <br /> fax: 952-249-4616 Fee: �—^ <br /> ,�, Mailing Address: ESCrow#8�$ � �' <br /> � � P.O. Box 66 <br /> '�' G� Crystal Bay,MN 55323-0066 Permit Fee <br /> j�kF S 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: f �}� �Cl� S�. Or�o, MtJ J�S�SCP <br /> DESCRPTION OF REQUEST: Ne.w �CK � ��-� �� <br /> (attached additional sheets as necessary) <br /> APPLICANT/AGENT INFORMATION• <br /> Applicant Name: �q0� A ma.rK <br /> Phone (Primary): (p�Z . Z.ps• lgQp <br /> Applicant Email: �Kp�,(-c�m�rK �{h'Y�11 • Lo�'►'� <br /> Address: t�U L.E44� .S�- City: �p Z�p: 55.33�p <br /> Applicant is: Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: L�lcheck here if property owner is same as applicant <br /> Name: __`�?'I/1� <br /> Phone (Primary): <br /> Mailing Address: City: 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 consuttant 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 andlor 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 project. <br /> ApplicanUAgent Signature: �[ 1t�C/ Date: �' L2- (p <br /> ApplicanUAgent Signature: Date: <br /> Property Owner Signature: Date: <br /> Property Owner Signature: Date: <br /> Variance Application—May 2016 l�EC E IV E D <br /> Page 2 <br /> JUN 2 2 �01C � � Q� j' � <br /> V `t <br /> C:ITY hF nRnNn <br />