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City of Orono <br /> Variance Application <br /> StreetAddress: q�p�b�# �b� i <br /> �O A rO 2750 Kelley Parkrvey <br /> j'� oro�,Mrv ssass Date Reoeived: - <br /> �a St�: m <br /> � Main: 952-245-4840 <br /> fax: 952-249-4816 Fee: <br /> � � Ma!!!nq Address: Escrow#8�$ <br /> *� P.O.Box 88 <br /> �' G Crystal Bay,MN 55323-0OBB Permit Fee <br /> �'�kE S H�4� Notes: <br /> Please complete. Applicant witl be notified within 15 days as to the status of the application. <br /> Incomplete applications will not be placed on Planning Commission A�enda. <br /> SITE LOCATfON: �-`� �-� C�.rvi•��•n <br /> DESCRPTIONOFREQUEST: }�v�-�-u,��urr�t�r� c�c��a� �.tt1,{- a�i�lr+-,. �,,,�-,�r ti�rl,�r n.�om r..r�c�r-�'�•�. <br /> {attached additional sheets as necessary <br /> APPLICANT!AGENT INFORMATION: <br /> APPlicant Name: '�=�?�-:r_.- "t3\;,��... �5�ro `;��� �-�t.-�'w� i� ���rr...c.�'t�,r-� <br /> Phone{Primary): ��`L-"��o ��7y�t.� <br /> AppiicantEmafl: p1,�{v� �}t„��.;� ,e,,.rn <br /> Address: 2S-t�3 C�rr+-+uw '�'t"' Cifi+: C7fo�-r� ZIP: ``�'�'�� t <br /> Applicant is: Contractor omeown {Circle One) -'� <br /> PROPERTY OWNER 1NFORMATlON:�check here if property owner is same as applicant <br /> Name: <br /> Phone(Primary): <br /> Mailing Address: __ Citv: Z1p: <br /> Ema"sl: �� � <br /> APPLICANT/AGENT ANDIOR OWNER: <br /> • Agree to provide alE information requfred or requ�ted by the Planning Departmerrt, <br /> • Agree to pay additional fees (staff Ume not covered in the arigirral fee payment)and/or consultant expenses Incurred in <br /> review of this application,and <br /> • Certffy that the infotmation supplied is true artd correct to the best of hlslher knowledge. The appl�ant and owner <br /> recognize that they are solely responsible for submittiag a complete eppiicatton being eware that upon failure to <br /> do so,fhe staff has no altemative but to reJect It urrttl It is complete or to recommend the request ior denial of the <br /> requeet rogardlea6 of its potentlal merfL <br /> • Acknowledge the Escrow Agreement is completed and sEgned. <br /> • The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property <br /> by City SUaff,consultants,agents,Commisslon and Councll Members for purposes of investigation ar�d veriflcation of this <br /> request. <br /> • Owner snd/or Appltcant acknowledge they must be present at all scheduled rovlew meetings of the Plannin9 <br /> Commissfon and Councll. If an applicent end/or owner is unable to attend a scheduled meeting, please make <br /> arrangements to have an authorized representative attend in place of the applicantlowner and advise the City Planner <br /> assigned to your proJect. <br /> ApPlicanUAgent Slgnature L,.��..y` ; '�`, ;-,=a��._. Date: ��(�'��� <br /> ApplicanUAgent SEgnature: Date: <br /> Property Ovmer Slgnature ` � - L l�`�.__ Date: �`1�la 'Z.c��' <br /> Property Owner Signature: Date: R .FIVED <br /> va►+a,�ap�er�,�—�r�y 2or s ��2 J U L � � 2 016 <br /> # 3 8 5 � ��no�oRo�o <br />