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. CityPc <br /> of Orono Exhibit A <br /> #17-3887 <br /> Variance Application <br /> 0 A Street Address: Application# //J—3� <br /> lJ 2750 Kelley Parkway <br /> Ilk O Orono,MN 55366 Date Received /05// / fv <br /> Staff <br /> e Main: 952-249-4600 'V{ �G � <br /> fax: 952-249-4616 Fee 7 <br /> A a„ Marling Address: ` <br /> •s• :, 'r. G�,c„ P.O.Box 66 Escrow#&$ 5� r✓f / <br /> Crystal Bay, MN 55323-0066 Permit Fee <br /> t-1kf S H O' Notes <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applications will=be placed on Planning Commission Agenda. <br /> SITE LOCATION: ZOl2 Stn4Lrrk-NA 2.8 <br /> DESCRPTION OF REQUEST: k►a S♦ for S i de. Iva-i S u.. 4o A 41c�:L, AAdti't-clt, c't ry c.4u - <br /> (attached additional sheets bs necessary) 4,0 , '"1 .., .i\+ ,r. <br /> APPUCANT/AGEIET INFORMATION: <br /> Applicant Name: {.vtSipn Li-C. - -t>141,1/41 bAt1 <br /> Phone (Primary): qSZ-SW8- 7ISo <br /> Applicant Email: J6hn 0 rr u i Si nn H,I , CdA^ <br /> Address: 153 t✓ Wee cf City: 14/tyZ�TL` ZIP: SS3. 1I <br /> Applicant is: on ra w • Homeowner (Circle One) ! <br /> PROPERTY OWNER INFORMATION: ❑ check here if property owner is same as applicant <br /> Name: Sie Pha.sjx, MO.--iiii 4. <br /> Phone (Primary): 9.5.1,— iy71- 63 Y c <br /> Mailing Address: 7 l l Nflol wwa. City:.��dfa •..Or b ZIP: s;s, <br /> Email: . ditt . VIL_ iuc.i t.tzn <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. I : applicant and/or owner is unable to attend a scheduled meeting, please make <br /> arrangements to have an a i •rized :presentative attend in place of the applicant/owner and advise the City Planner <br /> assigned to your project. <br /> Applicant/Agent Signature: G'..-- Date: 12-1 lb If <br /> IF <br /> Applicant/Agent Signature: <br /> _ Date: <br /> Property Owner Signature: aZielt.*e ��� Date: i,-/9/t, <br /> Property Owner Signature: Date: KtCEIVED <br /> Variance Application—May 2016 <br /> Page 2 DEC 14 2016 <br /> CITY OF ORONO <br />