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PC <br /> Exhibit A <br /> #17-3965 <br /> City of Orono ' <br /> Variance Application <br /> Street Address: Application# f -.3 9f).5- .. . <br /> 2750 Kelley Parkway • <br /> L '1 YO Orono,MN 55356 Date Recel ed: 1 Al.7 6...... <br /> N Main: 952-249-4600 Staff: - '' • ,r. <br /> fax 952-249-4618 `' �` = <br /> Fee: i.. . $700"" .,;... :.``• <br /> Haring Address: _, --.-. <br /> P.O.Bax 68 Escrow: .. -. $700 •'/.;;2,500 ' -4 31 s1 <br /> o'l� t• �G Crystal Bay,MN 563230088 Notes: rt:;'. _ ;N' <br /> kESHO' ';. <br /> .c, <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." 6 C -0 4)- C-0 ?ICI.1k IZA . <br /> DESCRIPTION OF REQUEST: <br /> (attach additional sheets as necessary) <br /> APPUCANT INFORMAT ON: 0 check h:: : If Applicant a...roes s ould b used for billing <br /> Applicant: _ 1-r v..extu-•-• <br /> Phone(Primary): ` "4C4- c. q� - t1.- ?.L •. ; • _ <br /> Mailing Address: o L 1IIIIIM0 Lox t Cit : ,,,,.•. i . it. ZIP: • <br /> Email: <br /> PROPERTY OWNER INFORMATION: 0 check here if Property Owner is same as applicant <br /> .t;he,here If P(� ddr s should be used for billing <br /> Name: b 2v't a ct � `�tr. <br /> Phone(Primary): Q 5'2-- 4 - 1°1 v4 <br /> Mailing Address: 24,C,C C0.�c4, y._:—.4 d. City: L) - z2 . ZIP: 55-2,c1 1 <br /> Email: t o' .Ire-rcn u..' 0 rAS r• . at n^ <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. tf 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 small. <br /> Applicant Signature: Date: S'2- 1 - I ?- <br /> ,..., <br /> Applicant <br /> 'Z1 - I ?- <br /> Applicant Signature: Date: <br /> / "'•1' <br /> Property Owner Signature: Ia .41 >1 rt>l� Eir <br /> Date: <br /> Property Owner Signature: 1aT='--r""" <br /> Variance Application—January sonR. T I <br /> Page! <br /> AUG 232017 3965 <br /> CITY OF ORONO <br />