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PC <br /> Exhibit A <br /> #173967 <br /> City of Orono <br /> Variance Application <br /> Street Address: Application# /7. 3 9(o <br /> 2750 Kelley Parkway <br /> �'1 ' rO Orono,MN 55356 Date Received: 7r-A3-17 <br /> Main: 962-249-4800 Staff: <br /> fax, 962.249-4816 Fee: $700 <br /> MagiAddress: <br /> P.O.Box e8 Escrow: $700 / $2,500 <br /> p tO �G Crystal Bay,MN 55323-0086 Notes: <br /> 'SEs tiOr <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: Jb p b r. U.)O moo -Q ,VY1vJ 5539 <br /> DESCRIPTION OF REQUEST: VilfVet- *Cp.- ik013 Its ltd. <br /> (attach additional sheets as necessary) <br /> APPLICANT INFO TION' D eck here If App icaM�Gould be used for billing <br /> Applicant d�l.S Rc�,,�k,, <br /> Phone(Primary): .—fp <br /> Mailing Address:, f „ afcti/ /OS City:14 ZIP: <br /> Email: bide-62'x*A • r ccsM <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: `SNr\k.cfir.n�\ .LL �o,.>r-e-g 5 O._ ^Me •-M-\ <br /> Phone(Primary): > xti a - `‘.\-kt> _ r-k 5 p <br /> Mailing Address: k O tD `j r j- , City: 1(Y‘,.4s .',1--,Q ZIP: 5 S 3 L%c <br /> Email: qt�m�V� �'�h t- <br /> APPLICANT AND/OR PROPERTY OWNER: <br /> • Certify that the information supplied is hue and correct to the best of his/her knowledge. The applicant and property owner <br /> recognize that they ere 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 'L / <br /> Applicant Signature: ! Date: fr/Z Z-//7 <br /> Applicant Signature: Date: <br /> Property Owner Signature: err r4 Date: 007 <br /> Property Owner Signature: k J 1_ _ � Date: Cj `a t- 1 <br /> Variance Application—January 2017 C E1VEp <br /> Page 4 <br /> AUG 2 3 2017 <br /> # 3967 <br /> CITY OF ORONO <br />