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PC <br /> Exhibit A <br /> City of Orono 17-3978 <br /> Variance Application <br /> Street Address: Application# / 7 --- 3 178' <br /> �,A TO 2750 Kelley Parkway <br /> f v Orono,MN 55356 Date Received: g- -1 `j <br /> �`� Main: 952-249-4600 Staff: <br /> � g <br /> fax: 952-249-4616 Fee: $7 T 7 <br /> A t e Mailing Address: <br /> y P.O.Box 66 Escrow: $/00 l $2,500 �1 0979-C <br /> fi` ' Crystal Bay,MN 55323-0066 Notes: l <br /> licks H 04` <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: L-P-C) 5 R11 <br /> DESCRIPTION OF REQUEST: LOT-AtraL g lith V V -J kJ <br /> (attach additional sheets as necessary) <br /> APPLICANT INFORMATION: ❑check here If Applicant address should be used for billing <br /> Applicant: it1/4(_`(`' 1C2uk [ V� <br /> Phone(Primary): c2—s4.'t3 ) i <br /> Mailing Address: 40( e. Z,,.�.1C.E City:164.k [Jac k ZIP: 52`7 t <br /> Emall: -}1i444tPt.irk e ale . . -r'co{ istt ycrctut coy\ <br /> rT�1.0t 0a3 -. - -r- ttrUQ'• <br /> PROPERTY OWNER INFORMATION: 0 check here if Property caner is same as applicant <br /> `heck here if Property Owner address should be used for billing <br /> XName: (eA Pc. 4I4%6E4410E2, <br /> Phone(Primary): (c0-2 S9*- -749 k.q. <br /> Mailing Address: (pS I LEjc-t t..- City EAtenp..4 ZIP: rz <br /> Email: "'1 kist+1n.M.E.St44Vr- -. MA-460. mor,. <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 emal. �f <br /> Applicant Signature: 1 <br /> - <br /> Date: —I F - /-7 <br /> Applicant Signature: Date: <br /> X. Property Owner Signature: •/ Date: l!1//Zr!'f- <br /> RECEIVED <br /> X Property Owner Signature: Date: <br /> Variance Application-January 2017 SEP 2 0 2017 <br /> Page 4 LP" 3- ati- r 7 CITY OF ORONO <br />