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<br /> PC Exhibit A �
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<br /> . _. �City of Or:ono . .
<br /> Va�riance Application
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<br /> � , StteetAddress; ` ?Ppiication# : �
<br /> �'O� 2750�Kelley Parkway Date Received: �
<br /> � � Orono, MN"55356 � ` . . : .
<br /> � � - .: . _ : Staff:
<br /> Main: 952-249-4600 . • � : Fee: $700 �...Q �� ' ;j�5�
<br /> ` fax: 952-249-4616 Renewal: $3�
<br /> • ��. � G�c4 . Mailing Address: � , After-the-fact: $1,400 double fee
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<br /> '� �- � P.O. Box 66
<br /> � 9kESHO� � � �:Escrow Fee; . -
<br /> . Crystal Bay, MN 55323-0066 � _ $2;500 new homel addition/.
<br /> - � `. : :-� � . , � . ;new structure ' .
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<br /> . . : $ -600 othervariance
<br /> This application form must be completed in fulL Applicant will be notified,within 1`5�days.as to the status of the ��
<br /> application: Incomplete applications will not be�placed �on Planning C.ommission:Agendas..
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<br /> PROPERTY 1NFORMATION:.,
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<br /> .Site Adtlress: . �� `I C-1�2�y �-�iw:S� ��'��' � , C1��nO� W►^b�
<br /> Property Identification Number,(PIN): `3C� - ����'� �3 - - 00�b '
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<br /> :DateProperty Acquired (month/year): O Yes, I own the adjacent parcels. .
<br /> Zoning District: ��� _ � . ..
<br /> APPLICANT�INFORMATION: (CompleteJegal names°and ma`rital status"re�uice_dfp�ch interested:party)
<br /> Narne: .� r� �„�' _�- � ,� , ,...
<br /> � c,� e�d;� � ���1c � �5��.. �'!ut6�
<br /> Phone (home)� ��a-��(7�- q iq�( Phone (woek)� ��I a.� zS�(O �-- ��/�g -Ceu
<br /> Complete PAddress: ( °i°l 'C (^��/v �t..�:� 'i�va� ..- _ �
<br /> City, State &ZI P , ; =CLC.�v.e, i'h r� °�S 3�j ( � . ; .
<br /> EmaiL• � � �' _f�C�a�'� �� �s�3'� ��J'YY� Fax: , , . -
<br /> , RMATION: (Complete le�al names and marital status required for each�interested party) ,
<br /> N meER INF��e_�t d�-�ee,aw. �'v�rtiv-,tL. �� �
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<br /> _ Rhone (home):� ���4'�' 75-4�'�f�' � Pfione (work): . ..
<br /> Complete�4ddress: ���i l.e�t.G�G•�:�:P ����V-C
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<br /> City, State &ZIP �c�k �. fi�, � (V�I� S�^3cj ( _
<br /> •EmaiL• � -. if�P_-V�rzyv'��t (w d�����'L:�/� Fax: - .
<br /> DESCRIPTION OF REQUEST: - . . .
<br /> Describe the reguest in detail�(attach additional sheets if necessary):
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<br /> Last lipiiafed: 6/27/2011 , ' .
<br /> ;` , ;.a . �,:� AUG -9 2011
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