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..-. <br />1�'�, <br />./�,,,, <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 />C1TY CODE SECTION 1013.05 <br />www.ci.roseville.mn.us <br />p C�C�C�OdC� <br />� �u� 2s Zoos <br />� �, <br />0 APPLICATION FEE: $75 ���i. '_" `�� :" c �, , r � ' .`�'} �'�'``�-' �;��' <br />(Fee should be made payable to Ciry of Roseville upon submittal of completed application.) ��l <br />Please complete the application by typing or printing in ink. Use additional paper if necessary. <br />1. Property Owner Information: <br />Last name: ' c�E- v� First name: (�y,�. -��C.1_�� <br />Address: / � ?j� 1�F��,���� Ciry/State/Zip: (�O�U/ � r �/l� �S J � � <br />Phone number: ��� �- S��S Email address: <br />2. Applicant Information: ('f different from above) <br />Last name: ���,t i_-i Z First name: �c:�,�t,�, S <br />Address: s�/f / f-{�(��P -��Jc City/State/Zip: �� -C,�et,tD /L�ru S�iOy _ <br />Phone number: (�;/ ��'7 f Email address: <br />3. Statement of Intent: Briefly describe what will be done on the property requiring the Setback <br />Permit. <br />�DD jN V �p C—r.w ^,��.- �iA�._ ��CT.�� a �R �N �F bD� 7.LMt �7�i �CwH�. <br />T�C�J ;��s.uA� ��..�.e t�� A � �T S`-�'�i :`� �r4S ?c2 <br />.�'Z�1.0 r �U C.� <br />4. Additional Required Information: <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 11 " or 11 "x 17" paper. <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 />, <br />L� <br />Applicant: <br />Date: �- � - C� ,�' <br />Date: � <br />