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p�- �H-r8�r �r <br /> City of Orono <br /> Variance Application <br /> streetadar,ess: j Application# <br /> �Q O A r 2750 Kelley Parkway ( ' b <br /> T" ��r/1 Orono,NIN 55356 � Date Received: <br /> t — �"� � Staff_ <br /> Main: 952-249-4600 <br /> Fax: 952-249�61 B Fee: i� �� <br /> ,3, "' MailiriQ Address: ESCrbW#&$ „SQ� <br /> Q Q� <br /> �� 1� P.O.Box 66 , <br /> G Crystal Bay,MN 55323-0066 i Permtt Fee <br /> t�k6S N��`'� Notes: <br /> Piease complete. Applicant will be notified within 15 days as to the status of the appllcation. <br /> Incomplete applications will r�be placed on Planning Commission Agenda. <br /> SITE LOCATION: 117�W�1�Ur���OiC��` V�t�R <br /> DESCRPTION OF REQUEST: �A �� r �� � <br /> (sttached additional sheets as nece sary) <br /> APPLICANT 1 AGENT�N�ORMA ON: 1 � <br /> Appiicant Name: �� �yQ C � ftxa <br /> Phone(Primary}: <br /> Applicant Email: <br /> Address: f� '' Cf : ��p; <br /> Applicant is: ontracto Hom wner (Circle One) <br /> PROPERTY OWNER INFQ�tMA ON: ❑ check here if property owner is same as applicant <br /> Name: <br /> Phone{Primary): ,-- r'�►�2_. ��..� � 7 _� -- . _ <br /> Mailing Address: i�7 r.�-;l��,�1a,z.,,.,,� City ��,�� ZIP• 5'��`3/ <br /> Email: �,.�r�,1d7�-c�.���,,,,,,.�Q,n <br /> APPLICANT/AGENT AIVD/OR OWNER: <br /> • Agree to provide all Information required or requested by the Pianning Department, <br /> . Agree to pay additional fees (stafF tlme not c�vered in the original fee payment) andlor cansultant expenses incurred in <br /> review of this application,and <br /> • Certify that the informatlon supplied is true and coRect to the best of his/her knowledge, The epplicar�t and owner <br /> recogniza that they are solely responsibla for submlttlng a complebe applicatlon being aware that upon faflure to <br /> do so,the staff has no altemative but to rejoct it until it is complete or to recommend the request for denial of the <br /> request regardloss of its potential meMt <br /> • Acknowledge the Escrow Agreement is completed and s�gned. <br /> • The Owner hereby acknowledges and agrees to thls applicatbn end further authorfzes reasonable entry onto the property <br /> by City Staff, consultants,agents, Commission and Council Members for purposes of Investigatlon arxf verific�tion of thls <br /> request. <br /> • Owner andlor Applicant acknowledge they must be presant at all schsduled revlew meetln�s of thQ Plannlnp <br /> Commisslon and Councfl. If an applicarrt and/or owner Is unable to attend a scheduEed meeting, please make <br /> arrangements to have an authorized representative attend in plaoe of the applicanUowner and advise the City Planner <br /> assigned to your project. <br /> ` a /�� /� <br /> ApplEcant/Agent Signature: Date: <br /> ApplicanUAgent Signature: � Date: <br /> Property Owner Signature: � Date: ��Zl��Ce <br /> Property Owrter Signature: RE�+E��fa� <br /> Verrance AppliCatlon–May 2016 P�z SLP 2 � j��h <br /> CITY OF ORONO � � � � � <br />