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City of Orono <br /> Variance Application <br /> -viL0 V Street Address: Application# f 7- 3 5 O / <br /> 2750 Kelley Parkway <br /> 4,4 O Orono,MN 55356 Date Received: 9—An —/ 7 <br /> Main: 952-249-4600 Staff: /A <br /> fax: 952-249-4616 <br /> Mailing Address: Fee: $700 <br /> �1 ► <br /> P.O.Box 66 Escrow: $700 / $2,500 <br /> Crystal rystal Bay,MN 55323-0066 Notes: <br /> k <br /> � FSH04 <br /> 2.-151 /dod <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: 33o2s Cry sf a44) '.0 <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: <br /> Phone(Primary): <br /> Mailing Address: City: ZIP: <br /> Email: <br /> PROPERTY OWNER INFORMATION: 1'check here if Property Owner is same as applicant <br /> NI check here if Property <br /> Phone(Primary): 6/2, SG. Z- KZ.3y <br /> Mailing Address: 33 Z 5 C.'- -w.( R411 Ret City: Orono ZIP: 64-31 <br /> Email: ?vet D/Y8 e-t-- <br /> ,(4hov.G•w+ <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: Date: <br /> Applicant Signature: Date: <br /> Property Owner Signature: S Date: /y 7 RECEIVED <br /> Property Owner Signature: �dLail Date: Py� $EF 9 0 ?Fro <br /> Variance Application—January 2017 ' <br /> Page 4 ft -igr 8 <br />