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City of Orono 00 �,iYj�,L,� <br /> Variance Application -r �-:)5re <br /> Street Address: Application# <br /> {Z C)I� - 2750 Kelley Parkway <br /> )r1PC":, <br /> " V/ Orono,MN 55356 Date Received: <br /> Main: 952-249-4600 Staff: <br /> fax 952-249-4616 ., �-� <br /> Mailing Address: Fee: �SP.O.Box 66 Escrow: X() <br /> I $2,500 <br /> Crystal Bay,MN 55323-0066 <br /> .gxES H OINotes: <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: VP/5 .ShackL/i. nr4 knaci <br /> DESCRIPTION OF REQUEST: <br /> (attach additional sheets as necessary) <br /> APPLICANT INFORMATION: 0 check here if Applicant address should be used for billing <br /> Applicant: SI„,t1L- C l-2 cf-r/ Zh./ ,.,!1 t <br /> Phone(Primary): __ g-0, — _ <br /> Mailing Address: loo 7 7rr-q.-1,-- " r"at----e- City: 4r-/1511C- ZIP: <br /> Email: - '7.d- L P.zrj 671dllrr. e,J}^- <br /> PROPERTY OWNER INFORMATION: 0 check here if Property Owner is same as applicant <br /> ,l 13 check here if Property Owner address should be used for billing <br /> Name: bild LIA.Y1ki- -Ea vtL-. <br /> Phone(Primary): <br /> Mailing Address: 'cos' lav .rr<<F,.-"„ itis W -k. / City: �I�vLt ZIP: <br /> 55(43/ <br /> Email: e,rrla✓\ . pal,.aS1-c <br /> i e bwhnn,,,, cook. <br /> l <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 99rrfail. 1 <br /> Applicant Signature: ' - Date: m (/"/ <br /> Applicant Signature: G Date: <br /> Property Owner Signature: ,1__ Date: eh/)//7 <br /> Property Owner Signatur=.:� Date: <br /> Variance Application—January 2017 <br /> Page 4 <br />