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<br /> �ity of Orono
<br /> Var�ance Applic��i�n
<br /> SheetAddress: Application# � �' (p— 'Jjg'� 'j,r
<br /> �O/�rO 2750 Kelley Parkway
<br /> ��� Orono,MN 5535G Date ReCeived dj � (�
<br /> � Main: 952-249-4600 Staff J�(�
<br /> faz: s52-2as-as�s Fee QO
<br /> ,� Meiling Addfess: �g�pyy#&$
<br /> �� � P.O.Box 66
<br /> G� Cryatal Bay,MN 55323-0066 Permtt Fee
<br /> ��k�sHo4� Notes
<br /> Please complete. Applicant will be not�ed within 15 days as to the status of the application.
<br /> lncomplete applications will not be placed on Planning Commisslon Agenda.
<br /> SRE LOCATIpN: �!'io Qc��, itA S C�ca.,o 5539�
<br /> DESCRPTION OF REQUEST: A►�, a �,r. 4►, 41e. ,ncoAest�., (flls,�s a��,,s1sa•�
<br /> (attached additional sheets as'necessary)
<br /> APPLiCANT 1 AGENT lNFORMATION:
<br /> Applicant Name: � �, , Re,,;sioh L�.�
<br /> Phone(Primary): 9sz-�o�-bn4 '
<br /> Applicant EmaiL• �,l�x(a, �t,,,;Siw�....c,�.
<br /> Address: t,�.k�, st Ci : W A ZIP: S 5?g�
<br /> Applicant is: Co tr tor Homeawner (Circle One)
<br /> PROPERTY OWNER INFORMATION: ❑check here if property owner is same as applicant
<br /> Name: T,,r,d�� n1 5��1,�c�, ..�� A�.. k SYIIi�Ah
<br /> Phone (Primary}:
<br /> Mailing Address: _ �s�to g,,,,,,� R�. S C�tY; oro,�,e ZIP� 55 S 9�
<br /> Email:
<br /> APPLICANTIAGENT AND/OR OWNER:
<br /> • Agree to provide all fnformation required or requested by tt�e Planning Department,
<br /> • Agree to pay edditional fees (staff time not covered in the original fee payment) and/or oar�suftant expenses incurred in
<br /> review of this application,and
<br /> ■ Certify that the ir�formatian supplied is true and correct fo the best of his/her knowledge. The applicant and owner
<br /> recognize that they are solely responslb{e for submitting a complete appllcation being aware that upon failur+e to
<br /> do so,the staff has no albemative but to reject it until it Is complete or to recommend the request for denial of the
<br /> request regardleas of Its pofiential merit
<br /> • Adcnowledge the Escrow Agreement is compteted and signed.
<br /> • The Owner hereby adcnowledges and agrees to this application and further authorizes rsasonable entry onto the property
<br /> by City Staff, consultants,agents,Commissian and Council Members for purposes of investigaUon and verification of this
<br /> r�equest.
<br /> • Owner andlor Applicant acknowledge they must be pr+essnt at all scheduled r+eview meetings of the Planning
<br /> Canmission anci Councif. If an applicant andlor owr�er is unable to attend a scheduled meeting, please make
<br /> arrangements to have an authorized representative attend in place of the applicarrtlowner and advise the City Planner
<br /> assigned to your project.
<br /> Applicant/Agent Signature: Date: ��24�1�
<br /> Applicant/Agent Signature: Date:
<br /> Property Owner Signature: Date: �� S� �D/(,�,,.,�
<br /> D
<br /> Property Owner Signature: Date:
<br /> v�r►e.,��a�r;�erro►,—n�y Zo�s
<br /> S�� � � �n��
<br /> Paye 2
<br /> � �� � � ClTY OF ORONO
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