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PC <br /> Exhibit A <br /> City of Orono #17-3918 <br /> Variance Application <br /> Street Address: Application# <br /> !q�O �O 2750 Kelley Parkwayt <br /> V Orono,MN 55356 Date Received: <br /> Main: 952-249-4600 Staff: <br /> fax: 952-249-4616 Fee: $700 <br /> Mailing Address: <br /> 1. P.O.Box 66 Escrow: $700 / $2,500 <br /> tG Crystal Bay,MN 55323-0066 Notes: <br /> RFSHOR <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: /0 /c Fpyh dy( i Pea A k✓ts4 / OrohS <br /> b 53 7 <br /> DESCRIPTION OF REQUEST: _ <br /> 1 (attach additional sheets nec ssary) <br /> APPLICANT INFORMATION: 0 check here if Applicant address should be used for billing bens ekt S <br /> Applicant: T(ZN.. A-L 0i Ka IsAi? L ari, Re MMP L art 441A`1-(..4A- <br /> Phone (Primary): (p ( 2_ . $S- * 1-$' <br /> Mailing Address: 21 3 . IN454- s,/ 3"J 5}_ City: ,AUT I s ZIP: ccjj 0 <br /> Email: 7e2H e 1' k k ly iF. 1 vs...... Cow._ <br /> PROPERTY OWNER INFORMATION: 0 check here if Property Owner is same as applicant <br /> .check here if Property Owner address should be used for billing <br /> Name: Fji(I Tole, <br /> Phone(Primary): q s2, - 2.40 - 2/0 0 <br /> Mailing Address: 2 570 CVI5( ,!)♦ gjJ goad City: Mihntivrtk9 ZIP: 5-S-305— <br /> Email: 5-S-305— <br /> Email: 1AM-0 le 5 104 l e 00�[ow`.. <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,_ Date: 2 •/ y. /1 <br /> Applicant Signature: dir Date: <br /> t <br /> Property Owner Signature: .,-/' --0----1.#‘-''--------....„ Date: 1(4." -71 G ' c '7- <br /> Property Owner Signature: Date: <br /> Variance Application--January 2017 <br /> Page 4 <br />