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PC <br /> Exhibit A <br /> City of Orono 17-3972 <br /> Variance Application <br /> Street Address: Application# /7- d - <br /> ,C-0.-/�>O 2750 Kelley Parkway <br /> / Orono,MN 55356 Date Received: G�--11-aD 1 7 <br /> - . Main: 952-2494800 Staff: <br /> C.--- <br /> fax: 952-249-4616 Fee: �-7 <br /> }.. <br /> Malting Address:PO.Box 68 Escrow: it I(a, <br /> Crystal Bay,MN 55323-0066 M'kEsioNotes: <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: 'ci 20 S- 'n/co 000 R3 <br /> DESCRIPTION OF REQUEST: IP tD 'L T JC A 2C X 3q- CiLrActiE13 CoAf tha> To Mr�PICE. lira <br /> (attach additional sheets as necessary) <br /> F„Kiriuc-, Z2x 24 6ARgQ - rno,kurPii )ktisri uc s_TBACKs t4mo 1441,c .? CQVAC jE . <br /> APPLICANT INFORMATION: 0 check here if Applicant address should be used for billing <br /> Applicant: ._)AN 1' CoA5mm_PTPo <br /> Phone (Primary): (05 I - 3.5 7. 3282 <br /> Mailing Address: 1°)240 St tai t t9 p f O City: CIW)).1 i ZIP: ,5fi_39' 1 <br /> Email: JPrNpic�TPY� t\Ptz €YO, re- <br /> PROPERTY OWNER INFORMATION: Vt 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 email. , <br /> Applicant Signature: ,ii P.,A - r.. ��/.,!u! / <br /> . Date: CC. <br /> I I /1 7 <br /> Applicant Signature: Date: <br /> C i t <br /> Property Owner Signature: ,. .&,A, " iftliM,, EicarEDR/1 ii i 7. <br /> Property Owner Signature: SEb tel: 2017 <br /> Variance Application-January 2017 <br /> Page 4 CITY OF ORONO # 39 72 <br />