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Vlance iCity of Orono <br />� ti <br />Str wt Address: Application # <br />2750 Kelley Parkway <br />Orono, MN 55356 Date Received: <br />Main: 952-249-4600 f Staff <br />fax: 9522494616 Fee: 6700 <br />MaNngr Address <br />P.O. Box 66 Escrow: $700 / $2,50a <br />Crystai Say, 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 pla d on Planning Commission Agenda. <br />SITE LOCATION: � eft T S14 Rr <br />DESCRIPTION OF REQUEST: <br />as <br />APPLICANT INFORMATION: ❑ check here if Applicant address should be used for billing <br />Applicant: �a_ t Uq._ �1J11 t 5r <br />Phone (Primary): 4 g <br />Mailing Address: _ .Z.L _A74ZI_ Pam_ <br />Email: <br />PROPERTY OWNER INFORMATION: check here if Property Owner is same as applicant <br />❑ check hen; if Property Owner address should be used for billing <br />Name: <br />Phone (Primary): <br />Mailing Address: CRY: 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 acknqMedge they must be present at all scheduled review meetings of the Planning <br />Commission and Council. If an applir nt and/or propsAy owner Is unable to attend a scheduled meeting, please make <br />arrangements to have an authorizagepresentative end in place of the applicantlowner and advise the City Planner <br />assigned to your project. / <br />f <br />• <br />Information will be distributed ` 1M <br />Applicant Signature: i <br />Applicant Signature: Date: -- <br />Property Owner Signature: r fig Date: <br />Property Owner Signature: Date: DECEIVED <br />Variance Application — January 2017 <br />Page s SEP 2 0 Z01 f <br />#3980 CITY OF ORO"NO <br />