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„ <br /> y PC <br /> Exhibit A <br /> City of Orono �� #17-3942 <br /> Variance Application <br /> Street Address: Application# i-1 - .?G 4Z <br /> 0 2750 Kelley Parkway <br /> `` � <br /> �O Orono,MN 55356 Date Received: O E' ( U j 7 <br /> Main: 952-249-4600 Staff: L V l v <br /> fax: 952-249616 Fee: $700) P� C 1[ 04 <br /> I $2,50 pd C I� c- 4 <br /> .1 Mailing Address: <br /> ' �, P.O.Box 66 Escrow:G� Crystal Bay,MN 55323-0066 Notes: <br /> kOS H OV.t <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applications <br /> -will not be placed on Planning Commission Agenda. <br /> SITE LOCATION: i (o �� / 7 'J fir- ) a'L' - <br /> DESCRIPTION OF REQUEST: c?-b ce. d” • /Y 'it , ZG 7L 642/)- e-X1v7 u,70/ - <br /> (attach additio al sheets as necessa .4' <br /> APPLICANT INFORMATION: beck here ifApplicant address should be used for billing !)�7/1 ''Z(--- '2'`' <br /> Applicant: II,Y/ Luh' ,5-9;.17-- <br /> Mailing <br /> id.� <br /> J 1C l eff/� <br /> CC/ J4 <br /> Phone(Primary): eG/4A 1qe/_ � J� <br /> Mailing Address: /94,2,A C ' / A ,.."7.5 City: p7 X'jk�- ZIP: h-5330 <br /> Email: io/i nion/ <br /> ?7e,-).,f.,/?.r,i' - <br /> PROPERTY OWNER INFORMATION: ®'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 ail. <br /> Applicant Signature: , .0.1/n��� Date: �J -/ <br /> 7 <br /> Applicant Signature: 0 Date: <br /> , <br /> 1 • <br /> Property Owner Signature: lZy•7Date: 7-) -/ 7 <br /> Property Owner Signature: Date: <br /> Variance Application-January 2017 <br /> Page 4 <br />