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Pc <br /> City of Orono Exhibit A <br /> 17-3966 <br /> Variance Application <br /> Street Address: Application# n _ 39(p(p <br /> SLO/A rO 2750 Kelley Parkway <br /> 4,4 �/ Orono,MN 55356 Date Received: R -23 -11 <br /> Main: 952-249-4600 Staff: w ICK, <br /> fax: 952-249-4616 Fee: $700 <br /> A Mailing Address: <br /> l'e P.O.Box 66 Escrow: $700 / 2,50 <br /> t ► G~ Crystal Bay,MN 55323-0066 Notes: <br /> "kFSNO1" , <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incompleteapplicationswill not be placed on Planning Commission Agenda. <br /> SITE LOCATION: !5 a3 L lalk/Cl L ULc -8./i/ <br /> DESCRIPTION OF REQUEST: <br /> (attach additional sheets as necessary) <br /> APPLICANT INFORMATION: 0 check here if Applicant address shotbe used f billing Sc,..,__,, l . L-1 O,- <br /> Applicant: LOeL;j--f� C(LS itvC. AalL. 47r <br /> Phone(Primary): t"q l2 -(AS - C,(.0(c) <br /> Mailing Address: W2yt Rs-4r' c- City: V`1. LA LP ZIP: c4-/,3 <br /> Email: L b K-- Qui IJP FASO,N4A . Cts w- S G71.i'4 Lbe-Yat•Nes .L,�t <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: L./1uDrl- b4,tA-cLx a 1 i-r‘S_ <br /> Phone(Primary): 7 3 Li 4 9 -ci S <br /> Mailing Address: y 3 6, P6 >vu ca „f / ( >'�et„ City:il% y74.Ai ZIP: 5-,5—,3W <br /> Email: 44A L D V A-o i .C.- i <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 distribut: viae i. 5(,,v p_ 1,1) t ,e_S • a J r-. <br /> L.DIL <br /> Applicant Signature: 2�P 5LDate: 5111,/)2 <br /> Applicant Signature: Date: <br /> Property Owner Signature: , Yz m.ee- , . Date: _ ) 4 /7 RECEIVED <br /> Property Owner Signature: Date: AVG 2 3 ?0111 <br /> Variance Application-January 2017 <br /> Page 43 �3 6At. <br /> r Fa„7 ; CITY OF ORONO <br />