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, <br /> • <br /> PC <br /> Exhibit A <br /> City of Orono #17-3980 <br /> Variance Application <br /> -"�. Street Address: <br /> �Q /�T • 2750 Kelley Parkway Application# <br /> ` 952- 49600 Orono,MN 55356Date Received: <br /> �I Main: Staff: <br /> I2fax: 952-249-4616Fee: $700 <br /> _. .,,, j Mailing Address: <br /> Fi ` / P.O.Box 66 Escrow: $700 / $2,500 <br /> G Crystal Bay,MN 55323-0066 Notes: <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applications will not be plaJ ed on Planning Commission Agenda. <br /> SITE LOCATION: fl V r S1 Nl <br /> I, <br /> DESCRIPTION OF REQUEST: r ii1 ,t•/� Pm/114 Sfrw,kit V L I ' f....II 1,a,litI,�1 <br /> (alta additional heets as ne essary) <br /> APPLICANT INFORMATIQN: 0 check here if Applicant address should be used for billing <br /> Applicant: r IIYW h UIQ t 541 1,4400, <br /> 0, <br /> Phone(Primary): — <br /> Mailing Address: 2.411S( a114 t . al p r City: (yi(t5,r( ZIP: 5S 3 3 <br /> Email: SW IS 4►14r1el t . ro_ La dirt <br /> PROPERTY OWNER INFORMATION: heck 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): _ v <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 ackn• ledge they must be present at all scheduled review meetings of the Planning <br /> Commission and Council. If an appli ,nt and/or prope•y owner Is unable to attend a scheduled meeting, please make <br /> arrangements to have an authorized epresentative . end in place of the applicant/owner and advise the City Planner <br /> assigned to your project. <br /> • Information will be distributed . -r <br /> 4, <br /> Applicant Signature: ' A,A / ate: q.f0,1 <br /> Applicant Signature: WM, Date: q ' >7l 1 <br /> /tiff f <br /> Property Owner Signature: IVDate: <br /> Property Owner Signature: Or <br /> Date: <br /> Variance Application—January 2017 <br /> Page 4 <br />