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City of Orono <br />Variance Application <br />5treetAddress: <br />Application # <br />2750 Kelley Parkway <br />Orono, MN 55356 <br />Date Received: <br />Staff <br />Main: 952-249-4600 <br />fax: 952-249-4616 <br />Fee: <br />Mailing Address: <br />Escrow # & $ <br />P.O. Box 66 <br />Crystal Bay, MN 55323-0066 <br />Permit Fee <br />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. <br />SITE LOCATION: �L4 t 3 CC V-nAC1.1 5-t` <br />DESCRPTION OF REQUEST: Ica -co,-Ar1A %'1J 9&*015A- 1a9...4jk.-� o,4r-k'-1 ,Q,,AS 11V1tcf rb0.11 rxd+c��p <br />-'.,., <br />(attached additional sheets as necessary) <br />APPLICANT / AGENT INFORMATION: <br />Applicant Name: IDeir.r '%kqt , <br />Phone (Primary): 2,_ <br />^ Applicant Email: <br />Address: +'2-.413 CG►nn4r1++ '5t" City: p�-bv?0 zip: <br />Applicant is: Contractor <br />(Circle One) <br />PROPERTY OWNER INFORMATION: Xcheck here if property owner is same as applicant <br />Name: <br />Phone (Primary): <br />Mailing Address: _ _ City: ZIP: <br />Email: — <br />APPLICANTIAGENT 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 />ApplicanttAgent Signature: � ��'t '� Z� _ Date: oo -MA%'P <br />Applicant/Agent Signature: Date: <br />Property Owner Signature: ��1 �-_ Date: <br />Property Owner Signature: Date: RFCFIVF <br />Variance Application — May 2016 <br />Page 2 <br />JUL 18 2016 <br /># 3851 <br />CITY OF ORONO <br />