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PC <br /> i Exhibit A <br /> #17-3927 <br /> City of Orono MAR `Ull <br /> Variance Application CITY OFORONO <br /> Street Address Application# / 7— 3 ! t 7 <br /> iO A ,O 2750 Kelley Parkway <br /> �/ Orono,MN 55356 Date Received: -3- / 5-- / 7 <br /> Main: 952-249-4600 Staff: M <br /> fax: 952-249-4616 Fee. <br /> $$77001:40/ /7C$---2,350:A7 <br /> 700 <br /> j y Mailing Address' <br /> S P.O.Box 66 Escrow: $700 / $2,500 <br /> F L> Crystal Bay,MN 55323-0066 <br /> `•kEs Ft OV't Notes: <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: 825 Forest Arms Lane <br /> DESCRIPTION OF REQUEST: Please see attached. <br /> (attach additional sheets as necessary) <br /> APPLICANT INFORMATION: a check here if Applicant address should be used for billing <br /> Applicant: Nathan andBeth Brandenburg <br /> Phone(Primary): 612-337-6114 <br /> Mailing Address: 825 Forest Arms Lane City:Orono ZIP: 55364 <br /> Email: nathanbrandenburg@siegelbril.com <br /> PROPERTY OWNER INFORMATION: CS check here if Property Owner is same as applicant <br /> 0 check here if Property Owner address should be used for billing <br /> Name: <br /> Phone(Primary): <br /> Mailing Address: 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 will be distributed via em ' <br /> Applicant Signature: f :::t�� �J ,, Date: -%�j --2.,..%�-• <br /> Applicant Signature: Wil li- Date: 7 -If" )"Of 7 <br /> Property Owner Signature: .-----77z4 _, Date: -3 -t S--z....t'-- <br /> Property Owner Signature: eat <br /> �1 t /(C Date: -I r <br /> Variance Application-January 2017 <br /> Page 4 <br /> * 3927? 7 <br />