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��t� of Orono <br /> 1�ariance �pplication <br /> �� StreetAddresa: Appllcetion# /�rj —� <br /> 2750 Kelley Parkway <br /> � Orono,MN b5356 Date Reoelved: — <br /> hAain: 952-249-46Q0 Staff: � <br /> la�c 952-249-4616 Fee: <br /> ,.� " �ual�r�Address: Escrow#8�$ <br /> � P.O.Box 66 <br /> �� 1 <br /> G Crystal Bay,MN 55323-0068 Permit fee <br /> �'�kbS H 04� Notes: <br /> Please camplete. Applicant wlll be notified wfthin 15 days as to the status of the appllcation. <br /> Incomplete applicatlons wlll,nst be placed on Planning Commission�enda. <br /> SITELOCATi�N: �-`'f �� �',�c.rvtn�h �:��" <br /> DESCRPTiON OF REQUEST: }���_�.,��,�ry,h trq ��� �.,11►:�" v.c�{-4-,1r�-, ,C�.,,� �t V'tL.n ,,t,Dm cx�r��,�,. <br /> (attached additlona!sheets as necessary d <br /> APPLICANT/At3EHT INFORMATION: � <br /> APPlicant Name: '���..-- `t�4 -t;e ar-t� t�., � :�,� i� Gc���v�,�-�a,�,� <br /> Phone{Primary): <br /> Applicant EmafL• f F �. �,;t ,e;,,,r►, <br /> Address: _.f-St3 �r.rn��+� S'[" Citv' t��o�no ZIP• ���'`� � <br /> Applicant is: Contractor omeown (Circle One) ' —'� <br /> PROPERTY OWNER INFORMATlON:,�cheGc here if property owner is same as appfipnt <br /> Name_ <br /> Phone(Primary): <br /> Mailing Address: City: . <br /> Z!P• <br /> Email: � <br /> APPLICANT/AGENT AMD/0R OWNER: <br /> • Agree to provicie sl!information requlred or requested by the Planning Departrnerrt, <br /> • Agree to pay add�Uonal fees {8taif time not co+tered in the origirra!fee payment)and/or consultant expenses incurt�ed in <br /> revisw of this applic�tlon,and <br /> • Certify that the fnforma6on supplied is true artd correct to the best of hls/t�er knowledge. The appl�ant and ovmer <br /> recognlze that they are solely responslbfe for submttting a complete appiication befn� aware that upcn fsilure to <br /> do ao,the staff has reo aFtemsWe but to roJaat It untll It Is complefie or bo recommand the request for denlal of the <br /> request rogartlless of Its poteertial merit. <br /> • AdcnowEedge the Escxow/�r�ment is completed and sfgnsd. <br /> • The Owner hereby ackrtowledges and agrees to this applic;ation and further authorizes reasonable entry onto the property <br /> by City Staff,consultants,agents, Commisslon and Councll Members for purposes of investigation end veriflc�tion of this <br /> request. <br /> • Owner andlor AppEtcant aclv�owlsdge they must be present at all scheduled rovlew meetlngs of the P{annfng <br /> C�mmission and Councll. If an appiicarrt end/or awner is unable to atfend a scheduled rneeting, pfease make <br /> arrangements to heve an authorized representative attend €n place of the applfcaM/owner and advise the City Planner <br /> asslgned to yaur pmJed. <br /> � <br /> licant/ ent Si nature: � 's...�;::�=:�-� �`�''1 � I <br /> APP A9 9 _ __�.�, t_S�ti__..._ Date: ��kb!�� . <br /> ApplicanUAgent Signature: Date: <br /> � <br /> Property Owner Slgnature: ��`4-�"`-=� _�^"^��'�,:.. �" ;„_ �a � <br /> Date: ��l '?�3 <br /> Property Owner Signature: Date: �?F(':�I1�C17 <br /> varisnce Appncsaon—May 201 s <br /> �2 �u� � � zots <br /> � � V� � � CITY OF�ORONO <br />