Laserfiche WebLink
City of Orono <br /> Variance Application PC Exhibit <br /> Street Aar: Application# ! 1— ''Ra 9 <br /> A:� 2750 001,MKalfN�+dS3S6 Parkway Date Received: DUI—t li 7 <br /> Y 075 <br /> P.- M.in: 952-zw-4eC0 <br /> *4* - <br /> Staff: )640 <br /> for 962-249-461e Fee: '" <br /> y:-, Wing Address: Escrow#s$ 1120-- <br /> - 1 i E P.O.Bax es <br /> G Cryan Bay,MN 56328-0088 Permit Fee <br /> 'IkFSHOV Notes: <br /> Please complete. Applicant will be notified within ¶5 days as to the status of the applicator, <br /> Incomplete applications will <br /> } be placed on Planning Commission Agenda. <br /> f� <br /> SITE LOCATION: SS 2-0 A-V Pi 2 L V1 <br /> DESCRPTION OF REQUEST: -0}a"NG Cot W►A '' Y44 r►CCD <br /> (attached additional sheets as necessary) <br /> APPLICANT!AGENT IWFORL,ATION: <br /> Applicant Name: 6 i \VAC! <br /> Phone(Primary): C, t Z 70 3 cici <br /> Applicant Email: C1,4 Ps t t t- 1c. l oc.�d a C© �1 <br /> Address: 418,?S 1-�.,o►.1noV2i� Qct City:cad City: t ZIP: 5526il <br /> Applicants: Contractor Homeowner (Circle Ons) <br /> PROPERTY OWNER INFORMATION: )(check here If property owner Is earns as applicant <br /> Name: <br /> Phone(Primary): <br /> Mailing Address: � _ City: ZIP: _ <br /> Email: <br /> APPLICANT/AGENT AND/OR OWNER: <br /> • Agree to provide al Monnabon required or requested by the Planning Deparknert, <br /> A• gree ofew pay� (staff time not covered kr the original fee payment)and/or consultant expenses incurred In <br /> application,and <br /> • Certify that the information suppled 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 1s 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 /> Applicant/Agent Signature: ! Dots: o 2/0 7/" <br /> Applicant/Agent Signature: Date: <br /> Property Owner Signature: Date: <br /> ' a E0 <br /> Property Owner Signature: Date: <br /> v ,.ApplaxtIon_M,2016 � 3 ®8 <br /> Pz FEB 0 72017 <br /> CITY OF ORONO <br />