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Pe- 4E?cH air A <br />City of Orono <br />Variance Application <br />Street Address. <br />Application # <br />2750 Kelley Parkway <br />i <br />Orono, MN 55356 <br />Date Received: <br />Staff : <br />Main: 952-249-4600 <br />fax: 952-249-4616 <br />Fee: <br />Mailing Address: <br />Escrow # & $ <br />P.O. Box 66 <br />Crystal Bay, MN 55323-0066 <br />I Permit Fee <br />1 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 />SITE LOCATION: I I7 LJI 1192 1 foj r� tom. <br />DESCRPTION OF REQUEST: <br />APPLICANT 1 <br />Applicant Nam <br />Phone (Primar <br />Applicant Ema <br />Address: <br />Applicant is: <br />(attached additional sheets as necerssary) " <br />PROPERTY OWNER IN <br />Name: <br />Phone (Primary): <br />Mailing Address: <br />Email: <br />FQRMAIKON: ❑ check here if property owner is same as applicant <br />APPLICANVAGENT 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 />V 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 applicantlowner and advise the City Planner <br />assigned to your project. <br />1i/ Applicant/Agent Signature: Date: <br />Applicant/Agent Signature: a Date: <br />Property Owner Signature: Date: <br />Property Owner Signature: REGEIIIiQ <br />Variance Application — May 2016 SEP 21 1.011 <br />Page 2 <br />CITY OF ORONO <br />Z1114fe <br /># 3871 <br />