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City of Orono <br /> Variance Application PC Exhibit <br /> 40.A street Address: Application# /7-391)9 <br /> 2750 Kelley Parkway <br /> O Orono,MN 55356 Date Received: a- 8—D..1317 <br /> Main: 952-249-4600 Staff: <br /> fax: 952-249-4616 ""_—� <br /> A , a,, Mailing Address: <br /> Fee: $700 % Cr._ /(�C> <br /> 1„ ' P.O.Box 66 Escrow: 700 $2 r-y_( <br /> �G Crystal Bay,MN 55323-0066 Notes: �` ' rjG f <br /> l�xEs i i 0v- <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--7 5:5- Etk R-1 Av i -e- -(r_ei 5 C P 0 l 1/11— <br /> DESCRIPTION OF REQUEST: <br /> (attach additional sheets as necessary) <br /> APPLICANT INFOR�A��TI�ONa❑ci�ck��hQre�gppli�nt addre�should,pf used for billing <br /> Applicant: k A <br /> Phone(Primary): 9 5 3 S 17 - 4b(p <br /> Mailing Address: 221.5-5- E �l Ike, City:VI/Asy-7i t& 5 <br /> ZIP: 5341 I <br /> Email: tC eyt5 a I e_r <br /> h . C_O►'f'1 <br /> PROPERTY OWNER INFORMATION: heck here if Property Owner is same as applicant <br /> check here if Property Owner address should be used for billing <br /> Name: <br /> Phone(Primary): — RECEIVED <br /> Mailing Address: <br /> City: zIP:FEB 0 g 2017 <br /> Email: <br /> APPLICANT AND/OR PROPERTY OWNER: CITY OF ORONO <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: <br /> "IR • : l'' 1, Date: I iZ <br /> /1-D 1 ..7 <br /> Ilk Applicant Signature: Date: t / /ZO (7 <br /> ,...3 <br /> 0 Property Owner Signature: ii— h.0 va[, .L,ii .. Date: (/--5/2-43 (1 <br /> Property Owner Signature: �,�,, �� s 1�1!�� Date: 1(Z'30 ( 1 <br /> Variance Application—January 201 411P , <br /> Page 4 <br />