Laserfiche WebLink
PC <br /> Exhibit A <br /> City of Orono #17-3971 <br /> Variance Application <br /> Sheet Address: Application# 2 <br /> '9....01�rO 2750 Kelley Parkway 7 U 9 7 1 <br /> ,itl�/ Orono,MN 55356 Date Received: <br /> Main: 952-249-0600 Staff: f(1i <br /> iit <br /> tax 952-249 4616 l q V / <br /> ...Me: Mailing Address: <br /> Fee: $700 �,7 1— .C C . <br /> 1P.O.Box 66 Escrow: $700 / 2,500 <br /> (7------ <br /> G'1.. <br /> � Crystal Bay,MN 55323-0066 Notes: <br /> kFSHOv- <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: 2.1 )9 P:'At2 <br /> DESCRIPTION OF REQUEST: t Q.4e4Nc L 4-154(0 5 .40-E 5 - <br /> (attach additional sheets as necessary) <br /> APPLICANT INFORMATION: 0 check here if Applicant address should be used for billing <br /> Applicant: �/ 004.Sei"i-�►-^ <br /> Phone(Primary): IV/..--ZSc, q, ov <br /> Mailing Address: 1023) seek i.kL rrpo City: 4Nc& ZIP:.5-5 3c[ <br /> Email: (ib A gf(L aw, € GM/-lt ` - z�-. <br /> PROPERTY OWNER INFORMATION: 0 check here if Property Owner is same as applicant <br /> 0 check here if Property Owner address should be used for billing <br /> Name: 5LJc: Lcj -4, <br /> Phone(Primary): <br /> Mailing Address: City: ZIP: <br /> Email: <br /> APPLICANT ANDIOR 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 'I. <br /> Applicant Signature: Date: <br /> Applicant Signature: Date: <br /> Property Owner Signature: ,:4, Date: d'/ > <br /> .7 <br /> Property Owner Signature: 4.111110-..... , Date: �' 3-9 <br /> Variance Application—January 2017 411111Page 4 <br /> 397ii <br />