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• <br /> PC <br /> Exhibit A <br /> City of Orono #17-3919 <br /> Variance Application <br /> ��f j Street Address: Application# �-� �i 1 <br /> ' •O 2750 Kelley Orono,MN 5356�y Date Received: 0242/1 1 1 <br /> Main: 952-249-4800 Staff: t 4 <br /> fax: 952-249-4616 <br /> Mailing Address: Fee: $700 <br /> S P.O.Box 66 Escrow: $700 / 52,500 <br /> l"f �+✓~ Crystal Bay,MN 55323-0066 Notes: <br /> k£S H 04 <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: ?1,17/CWI�V{1+()r0 i div.O1/1M() <br /> DESCRIPTION OF REQUEST: '_,, I �., , I,,, r, •t 7, • 1��,� O410 Si0 t cf c, 144 <br /> (at -ch addi onal sheets as ecessary) p 11,4 im S o dOWN S l� 1/44S <br /> APPLICANT INFORWATION: Pt.check here if Applicant address qhould be used for billing <br /> Applicant: ftSkit4.4j Amor.1. IhA. bo A <br /> Phone(Primary): U <br /> Mailing Address: <br /> Email: a sAAttAitQ i y.icAu,s4 W‘G•LDvvt <br /> PROPERTY OWNER INFORMATION: /-.check here if Property Owner is same as applicant <br /> S check here if Property Owner address should be used for billing <br /> Name: <br /> Phone(Primary): <br /> Mailing Address: <br /> 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 wiN be distributed a em ii. <br /> Applicant Signature: Date: 2/7A-11 <br /> Applicant Signature: Date: <br /> Property Owner Signature: Al LAL, AK A ei& Date: 1 IA - <br /> Property Owner Signature: lAilatd, Date: 2 / Z l l ZO/ 4- <br /> Variance Application-January 2017 <br /> Page 4 <br /> FEB 2 C 2017 <br /> 3 919 CITY OF ORONO <br />