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C Imo. PC <br /> City of Orono Exhibit A <br /> #17-3912 <br /> Variance Application <br /> Street Address; Application# <br /> /�T 2750 Kelley Parkway 11 ;� � — <br /> 1,7:3.,.. YO Orono,MN 55356 Date Received: bit,til Il <br /> / -. l <br /> _-- -. Main: 952-249-4600 Staff: �, <br /> fax: 952-249-4616 /� <br /> .k ? A., Mailing Address: Fee: V$700 <br /> 'y P.O.Box 66 Escrow: 1./$700�l $2,500 <br /> �l� %' �G <br /> ~ Crystal Bay,MN 55323-0066 • <br /> Notes: <br /> KFsxo� <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: 1x96 LO/ / ',y 74i, hiz.nvo et. Lot 31 J4 I 114414114 <br /> DESCRIPTION OF REQUEST: WT kl NP grygr„Gc Ali- — 5g-,1- / 5,t,C-fC <br /> (attach additional sheets as necessary) <br /> APPLICANT INFORMATION: 0 check here if Applicant address should be used for billing <br /> Applicant: 51-41 fc�____ g. (7Z K C.- <br /> Phone (Primary): 14,42 , --7rp_ 1 v 0 <br /> Mailing Address: City: ZIP: <br /> Email: <br /> PROPERTY OWNER INFORMATION: Zi check here if Property Owner is same as applicant <br /> 0 check here if Property Owner address should be used for billing <br /> Name: <br /> Phone(Primary): <br /> Mailing Address: City: ZIP: <br /> Email: <br /> APPLICANT AND/OR PROPERTY OWNER: <br /> • Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and property owner <br /> recognize that they are solely responsible for submitting a complete application being aware that upon failure to do so,the <br /> staff has no alternative but to reject it until it is complete or to recommend the request for denial of the request regardless <br /> of its potential merit. <br /> • The Property Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the <br /> property by City Staff,consultants,agents,Commission and Council Members for purposes of investigation and verification <br /> of this request. <br /> • Property 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 property 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 /> • Information will be distributed via email. <br /> Applicant Signature: �- +�- ,r • tom - Date: 0242/ <br /> Applicant Signature: Date: <br /> Property Owner Signature: Date: RFCEIVED <br /> Property Owner Signature: Date: r p q <br /> Variance Application-January 2017Page FEB 1 20 7 <br /> 4 # 3 912 CITY OF ORONO <br />