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PC Exhibit A <br /> City of Orono <br /> Variance Application <br /> Stree�Oi Y 2750leyParkwayApplication l to "3 �'02� <br /> O Orono,MN 55356 Date Received: /o -19-1 !o <br /> Main: 952-249-4800 1 Staff �y <br /> fax 952-249.4618 Fee 70 <br /> Melting Address: Escrow#S$ <br /> 1 P.O.Box 88 <br /> � <br /> G., Crystal Bay,MN 55323-0088 Permit Fee <br /> l7$ SHO�� ; Notes <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.�r <br /> SITE LOCATION: I t: i(14 ' iZe.t_ ,� £ z m4' IV Q <br /> DESCRPTION OF REQUEST: 5"cI ILA. t4 a.,b,., e.- ,E'/se,�•f-•� /-e. ? <br /> (attached additional sheets as necessary) <br /> APPLICANT/AGENT INFORMATION: <br /> Applicant Name: oa,, 12a4.0& — <br /> Phone(Primary): ri/P.— Y6 — ff' 8''x'7 G/A— 74 - 6 /c( <br /> Applicant Email: ret lw joy�f� r,....1 • tis.... <br /> Address: 3 6 ri City: Ll nt, ZIP: S5-",3 3 / <br /> Applicant is: Contractor neo ne Circle One) <br /> PROPERTY OWNER INFORMATION: ..ck here if property owner Is same as applicant <br /> Name: <br /> Phone(Primary): <br /> Mailing Address: City: ZIP: <br /> Email: <br /> APPLICANT/AGENT AND/OR OWNER: <br /> • Agree to provide all Information required or requested by the Planning Department, <br /> • Agree to pay additional fees(staff time not covered in the original fee payment)and/or consultant expenses incurred in <br /> review of this application,and <br /> • Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner <br /> recognise that they are solely responsible for submitting a complete application being aware that upon failure to <br /> do so,the staff has no alternative but to reject It until It is complete or to recommend the request for denial of the <br /> request regardless of its potential merit. <br /> • Acknowledge the Escrow Agreement Is completed and signed. <br /> • The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property <br /> by City Staff.consultants,agents,Commission and Council Members for purposes of investigation and verification of this <br /> request. <br /> • 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 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. 6 Ls J <br /> d <br /> Applicant/Agent Signature: (flam- /�,t' S -..— Date: `o/i $/.? /i c <br /> Applicant/Agent Signature: Date: <br /> Property Owner Signature: Date: <br /> Property Owner Signature: Date: RECEIVED <br /> Variance Application-May 2016 OCT 1 9 2016 <br /> Page 2 <br /> # 3882 CITY OF ORONO <br />