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PC <br /> Exhibit A <br /> City of Orono #17-3890 <br /> Variance Application <br /> Street Address: : Application# <br /> A, 2750 Kelley Parkway Date Received: <br /> iiitiLi.Vo <br /> VO Orono,MN 55356 <br /> Staff: <br /> Main: 952-249-4600 <br /> fax: 952-249-4616 I Fee: <br /> Mailing Address: Escrow#&$ <br /> • �` P.O.Box 66 Permit Fee <br /> F <br /> L Crystal Bay,MN 55323-0066 <br /> !10SH04�, Notes: <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applications will ngl be placedion Planning Commission Agenda. <br /> SITE LOCATION: 5/7 F N r1Flan�--c iUQcz-- <br /> DESCRPTION OF REQUEST: frkR-i rt?U( Ft)( 1-0 CA-7-1 j Q 1J OC 01 Try Mc,vu imavr5 <br /> (attached additional sheets as necessary) <br /> APPLICANT I AGENT INFORMATION: • <br /> Applicant Name: Ili. .* ' '10 it-,G <br /> Phone(Primary): � 1�� Z't O I. - 4711,775.2t55E5 <br /> Applicant Email: s ` ,� :- t • <br /> Address: jri�iPlw % •� - �:>�A �����1, ZIP: e) <br /> Applicant is: Co , or Homeowner (Circle One) lMAI <br /> PROPERTY OWNER INFORMATION: 0 check here if property owne is same as applicant <br /> Name: 'S`'gUr v4 'i rf-[-tr4- /4� /moi <br /> Phone(Primary): /faffR S- �Q� <br /> Mailing Address: S 7 /if::rii,Z4-j /f.4_ /Uacrr City: /ZZ�vpr1l'1tJZIP: 5531/ <br /> Email: SA5L�}-� � << _ <br /> APPLICANT/AGENT 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 /> • 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 applicant/owner and advise the City Planner <br /> assigned to your project. <br /> 3 Applicant/Agent9 > f <br /> Signature: Date: ll*/41'/(� <br /> Applicant/Agent Signature: Date: <br /> Property Owner Signature: Date: <br /> Property Owner Signature: Date: <br /> Variance Application-May 2016 <br /> Page 2 <br />