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Exhibit A <br /> City of Orono <br /> Variance Application <br /> Street Address: Application# <br /> �� (�/�TOi2750 27 <br /> Kelley Parkwayb MN55356Date Received: 952-249-4800 Staff <br /> fax 952-249-4616 Fee: <br /> A Mailing Address: Escrow &$ <br /> P.O.Box 66 <br /> ���� �G~ Crystal Bay,MN 55323-0066 Permit Fee <br /> kBSHOIL 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 <br /> on Planning Commission Agenda. <br /> SITE LOCATION: 1 So eco A-00A <br /> DESCRPTION OF REQUEST: Ste- 0...AltxtiAid <br /> (attached additional sheets as necessary) <br /> APPLICANT I AGENT INFORMATION: <br /> Applicant Name: ?Q f - pl.hr,( a s Ct 5C,14 J'I-I <br /> �t <br /> Phone(Primary): (co Ix) `15'6 -,1.7 05- <br /> Applicant <br /> SApplicant Email: PSc. h.r +4- wa.� cvr hair . Cm w1 <br /> Address: 2.7�"O f C- s c.o ori.+ a.O City: OV11A0 ZIP: 39 l <br /> Applicant is: Contractor 'omeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: 12 check 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 /> recognize 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. <br /> Applicant/Agent Signature: Date: <br /> Applicant/Agent Signature: Date: <br /> Property Owner Signature: Date: h r b <br /> Property Owner Signature: .L Date: " <br /> Ld 1 7 I lb <br /> Variance Application-May 2016 <br /> Page 2 <br />