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�� ���T � <br /> City of Orona <br /> Variance Application <br /> streer add►�ss.� /�p�liciation�F � <br /> ��,.o.�0 2750 Keliey P�kway -,� <br /> Orono,MN 55356 Ly�RgD��yed; .. Z�_ � <br /> - 1 �. AAetn; 852-249-4B00 ��' /1/l <br /> fax; 952-249-4616 �g: �. � <br /> �► ` Mel1b►g Ad[tess; <br /> '��, �t r P.O.Box 68 �BCt�V#�'� <br /> l,jk���� Crystal Bay.MN b5323-0068 P�TRt�t Fge <br /> � �: <br /> Please camp?ete. Applicant wil! be notified within 15 days as to#he status of the application. <br /> Incomplete applications will p,�be ptaced on Planning Commission Agenda, <br /> SITELOCATION: �3$D �,,,A �,� <br /> DESCRPTlO�1 OF REQUEST: <br /> (attached addi�onai sheets as necessaryj <br /> APPLICANT/AGENT INFORMATI��l: <br /> AppkcaM Name: ,,.�-E /yti �.r..t,�_ <br /> Phone{Primary}: �z — �'2„— �}-OOG -251- t <br /> Applicant Email: r,,"a <br /> Address: . �, : <br /> Applicant is: Contrac#or Homeowner {Clrcle One) �p' <br /> PROPERTY OWhtER iNFORMATION: ❑check here if property owner is same as appJicant <br /> Name: v�g �.r �L <br /> Phone(Primary): tl-gS _ ol <br /> Mailing Address: 50� ,,.� S Cft : 1 e ZIP: <br /> Email: _ L xE�-ru� �to?Gnn h-,L�.��,�+.. <br /> APPLICANT/AGENT AND/OR OWNER: <br /> • Agr�ee to provide ail i�forrnation requir+ed or requested by the Plenning bepartrr�•nt, <br /> • Aoree io pay additlonal fees(staff time not covered in the origlnal fee payrt�ent) andlor consultani expenses fncurrod fn <br /> review of this application,and <br /> • CertHy thet the in{ormation supplied Is true and corred to the best of his/her knowledge. The applicant and owoer <br /> recognize that H�ey ar+e aolety reaponslble for submittln8 a complete apptkation bping aware tfiat upon tailure to <br /> do so,the staf'f has no al�m�tive but to roJect It until it ts comple�e or to recommend the r�q�est for denlal ot tbe <br /> nequ�t regardless of ifs potentlai merlt, <br /> • Acknowiedge the Eacrow Agr,eement is compfebed and efgned. <br /> � The Owner hereby adcnowiedges and agrees ta this spplicaUon and further authorizes reasonable entry onto the property <br /> bY G�I'����sultants,agents, Commission and Counctl Members for purposes of irnestigatlon and verl�Cation ef this <br /> rec7uest. <br /> • Owaer andlor Applicant acknowtedge they must be present at sll schsdufed revlew meet�ngs of the Plaenl�g <br /> Commisafon and Cowtcfi, If an applicant and/or owr�e� is unable to atbend a sc�eduled mee' <br /> arrangc�rneota to have en authorized representetive atten �' P� m�e <br /> assigned to your proJecL place of the appficant/owner and advlse the(;ity planner <br /> ApplicanUAgent Signature: � '� <br /> bate: <br /> AppGcanUAgent Signature: Date: <br /> Property Owner Sigrtature: M f�� Date: �__ l(Q /�� <br /> Property Ormer Signature: �ate: RE -�IVED <br /> v8r►��—�y 2o�s <br /> P�2 � SFP 21 Z01� <br /> �` ,� � � � C�7�'oF oRONo <br />