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RECEIVED <br /> � �ity �f t�rarnQ <br /> Var�ance A, t�+cation SEP i 9 2016 <br /> �� PC ExhibitA <br /> CITY OF <br /> �� sc,�eer aaaness: App+ication# g(� <br /> 275D Keiley Paricyvay <br /> � Orono,MN 55356 Date ReoeHred: <br /> Mein: 952-2A9-4800 StafF: <br /> iax. 952-249�618 Fee: � O 6 �� <br /> �t T,s,. Melyrig Addrsss: Escr+ow�$� a6 <br /> '��, ti�+ P.O.Box 86 -Z . <br /> Cryatal Bay,MN 5532�0068 Permit fee <br /> ����S Ei O�� Not+ea: <br /> Please complete. Appli�ant will be notified within 15 days as to the status of the application. <br /> tncomplete applications will not be piaced on Planning Commission Agenda. <br /> SITE�OCATION: (�Z� r .�_�21t,�tZ�,L,�'�N�' I�'— p}�'� , <br /> �_ <br /> —,....�_�._,.,._.._." <br /> DESCRPTION O�REQUEST: TO Q'O RR�y 6L, 1S'�7 L'�6�'�t <br /> �� <br /> (attached additional sheets as necessary} �.�.t���i �g��,y� -Z;.r:.o s.r�2.�, <br /> APPLICANT!AGENT 1NFORMATION: � � ��s�� �t+� g.qrQA� <br /> Appiicant Name: t �rtwhJ �� �.�t.y� �3�2csrrt�►2 S� <br /> Phone(Primaryjt �- (0 3 -__,_ <br /> Applicant Email: Y E' �G O <br /> Address: � _ <br /> �� : 1 z�p: �S3�r <br /> Appticant is: ontra iiomeowner (Circle Oney <br /> PROPERTY OWNER INFORNAATIQN: O check ttere if property awner is same as applicant <br /> Name: � r- �. <br /> Phor}e(Primary): �2 � � z <br /> Mailing Address: _D ti4� pe ct� �'. : ZIP: <br /> EmaiL- � _ <br /> APPLICANT/ACiENT AND/OR OWNER: <br /> • Agrae to provide aq i�ortriatian required or requested by the Planning Departmerrt, <br /> • Agree to pay additiortal fees (staff time nat oovered "m the arigina!fee paymen� andlor consuRant expet�ses inctimed in <br /> neview oF this applicatio�,and <br /> • Ceotify tteat the ir�formation supplisd is true and co�rect to the best of his/her knowledge. The �ppticant and awt�er <br /> rec4gnfre that they are soiety responsible for submittfng a oompts6e application being aware that upon faiiure bo <br /> do so,the staff Fsaa na al�emattve but ta r+sject(t antli it is complebe or to recommend the nequest far dsnial of the <br /> request r�ar+dloss of ib pobentia!merit <br /> • Acknowledge the Escrow Agreerrtierrt is completed a�si�ned. <br /> • The Owner hereby acknowledges and agrses to this application and further euthorizes reasonable enby onto the propetty <br /> by Ciry Steff, consultents,agents, Commission and Counal Members for purposes of in�estigation and ver�f�caiiort of this <br /> request. <br /> • Owner andlor Appttcarrt acknowledge they mu�t be prosent at alf scheduled review meetings of the Plannfng <br /> Comrrtlssion and Councfl. If an s�ppficarrt andlor owner is unable to at#end a scfi�eduled meeting, piesse make <br /> arrangements to have an authorized representative attend in place of the applicant/owner and advise the City Planner <br /> assigned to your project. <br /> Apptican#/P�qent Signature: ��; 9 r <br /> ApplicantJAgent Signature: �#e. <br /> --�. <br /> Property Ornmer Signat�are: D�: � /�/ <br /> Property Ovmer Signature: - Da�e: <br /> vaNB�,a�;�r;��—arey zoze <br /> PaQe 2 <br /> � 38bb <br />