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��� � <br />�.,� J <br />COMMUNITY DEVELOPMENT <br />2660 Civic Center Drive •:• Roseville, MN 55113 <br />Phone: (651) 792-7005 •: Fax: (651) 792-7070 <br />SETBACK PERMIT APPLICATION <br />CI"I'Y CODE SECTION 1013.05 <br />www.ci.roseville.mn.us <br />� <br />; _--- <br />��� f � ' ,, � <br />D �� ► � i.� �� <br />JL'��i �, 9 ��Q08 <br />�� <br />C� APPLICATION FEE: $75 <br />(Fee shou/d be made payable ro Ciry of Roseville a�pon saibmittal of comp/eted application.) <br />Please complete the application by typing or printing in ink. Use additional paper if necessary. <br />1. Property Owner Information: <br />Last name: ���rv�, t� � First name: � � <br />Address: � ��� ('=-,G,r��,e yl��}� Ciry/State/Zip: �;�v�,1�-� �rVl l� � ��11 L� <br />Phone number: �(�S�> �-i�3�-1—�J l��j Email address: r�,,mine�,���-,��"�' �;,��5�} , <br />C..�:i" �c�. �c;`�y1k�i.rz' � Li���--�`-��� , C1�rti� <br />2. Applicant Information: (if different from above) � � <br />Last name: <br />Address: <br />Phone number: <br />First name: <br />City/State/Zip: <br />Email address: <br />3. Statement of Intent: Briefly describe what will be done on the property requiring the Setback <br />Permit. <br />�r� � � . t h e . e �s-��rtC� �.�1�r-ar�c Q � n���. r r.��\ ��r��e: -�c, \p � �1 ,u ;-�1n ma�v� �s�n:c�;-t:��. <br />� u� ����� �,I�����U� �('L���,�r��: G..� a. �DD c�r �� 1'��ri� llCr� -�� Cr�(l��u"\ S'��R�C���i�:, <br />-T�nf r � �;n k?�Z iD / �l��l`.CS,`C'C�S 6�r�'� �- � ' UJ ���. � CS..,�(\S���t'I l� UJ �TY\ <br />a,��S -��c� C� E.L.� c� t v`�-rZ��-�CS,-i t-`t�� �eu` dc�� �-L;�`r�c'� \`.��� _rzSL� � r��� �c�c� ��, S�£� <br />4. AdditionaT�2equired Information: C��� ��,��,��-�.\k. � �`��� "�` ��-`�� "`�"`��' <br />a. Proposed Plans: A scaled site plan showing the existing and proposed building footprints as <br />well as driveways, sidewalks, and patios is required. Simple elevation drawings showing the <br />proposed addition or new building will also be required if the Setback Permit request doesn't <br />apply exclusively to a driveway. The plans for may be on 8'/2"x 1 1" or l 1"x 17" paper. <br />"7�a..�ns .,u��,dr�r� t�(Luti. <br />b. Written Narrative: The written narrative should address the 12 criteria that must be considered <br />during review of Setback Permit applications; these criteria are listed in the document attached to <br />this application and in § 1013.05 of the City Code. <br />5. Signature(s): By signing below, you attest that the information above and attached is true and <br />correct to the best of your knowledge. <br />Properry Owner <br />Applicant: <br />� <br />'i i <br />, , ,, <br />•� �� � ��.� <br />Date: <br />Date: <br />l <br />