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. <br /> ity of Orono PC ExhibitA <br /> Variance Application <br /> StreetAddress: Application# -- '3 g'� <br /> �O/�TO 2750 Kelley Parkway <br /> ` w Orono, MN 55356 Date ReCeived: � j <br /> Main: 952-249-4600 StBff: <br /> fax: 952-249-4616 Fee: ''7' `� `'��� �1 r� �•�� <br /> .� �, Mailing Address: EsCrow#&$ G U � <br /> y� ; P.O.Box 66 ,5���'� <br /> G Crystal Bay,MN 55323-0066 Permit Fee <br /> l�kFSH�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 /> � � �� <br /> SITE LOCATION: � V� h I � <br /> �. c <br /> DESCRPTION OF REQUEST: D C � <br /> (attached additional sheets as necessary) � ���� °rVn ��``/��� n,�� <br /> APPLICANT/AGE T I FORMAT �� �� lA°v <br /> Applicant Name: � <br /> Phone(Primary): <br /> Applicant Email: � , f1n^ <br /> Address: Cit : ZIP: <br /> Applicant is: Contrac or omeowne (Circle One) <br /> PROPERTY OWN R INF �2MATI0 : ❑ check here if p perty owner is same as applicant <br /> Name: h �f���. j <br /> Phone (Primary): �L B <br /> Mailing Address: Cit : Z�P: <br /> Email: s yt, � � . e � <br /> 1 <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 consultant 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 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 project. <br /> ApplicanUAgent Signature: � Date: `t L <br /> _Applicant/Agent Signature: Date: � <br /> Property Owner Signature: � Date: � �� l�' <br /> Property Owner Signature: �� Date: ��/ R�CEIVED <br /> Variance Application—May 2016 ��� � �"�O�c <br /> Page 2 U <br /> � � Q � � CITY OF ORONO <br /> V <br />