Laserfiche WebLink
PC <br /> Exhibit A <br /> City of Orono #17-3914 <br /> Variance Application <br /> /���a Street Address: Application# `] C f , <br /> 2750 Kelley Parkway <br /> Orono,MN 55356 Date Received. <br /> t a \ Main: 952-249-4600 Staff: <br /> fax: 952-249-4816 Fee: $700 ► ` <br /> Mailing Address: . <br /> . P.O.Box 66 Escrow: $700 / $ 500 <br /> �G Crystal Bay,MN 55323-0066 Notes: <br /> e.`.kfsti0 <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: 'T ii b H7 Li h wODdI ISO et-6L O rD t7D <br /> DESCRIPTION OF REQUEST: I (y X 16 cd d,..RC r) -s,e.e„ +1-m-cked <br /> (attach additional sheets as necessary) <br /> APPLICANT INFORMATION: 0 check here if Applicant address should be used for billing <br /> Applicant: Phi I I'ID 4 J)a-r A __ 6-f—f v <br /> Phone(Primary): <br /> cts2 _797^6,,q2.1:0 <br /> Mailing Address: J1b ft- A poet _12 City: � ZIP: b----'5-__042 <br /> _- . <br /> rim_ 5S�t�f_ <br /> Email: .1? - ,�� _-r. r o WJ _ <br /> PROPERTY OWNER INFORMATION: I11'check here if Property Owner is same as applicant <br /> Cl check here if Property Owner address should be used for billing <br /> Name: <br /> Phone(Primary): <br /> Mailing Address: <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 em twor,../..-"--. <br /> ! <br /> Applicant Signature: J. <br /> �, /� Date: Z - 20 - 1-7' <br /> Applicant Signature: Y.X . Q;�6 Date: a —/7 <br /> (4Property Owner Signature: Date: ��-' <br /> Property Owner Signature: d- tali,--- Date: .2 - -/ 7 RECEIVED <br /> Variance Application—January 2017 FEBq <br /> Page 4 <br /> # 3914 FB 2 2 L01 <br /> 7 <br /> CITY OF ORONO <br />