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RlJl, � <br />1�� <br />� <br />COMMUNITY DEVELOPMENT <br />2660 Civic Center Drive :• Roseville, MN 551 13 <br />Phone: (651) 792-7005 :• Fax: (651) 792-7070 <br />OPEN HOUSE ADDRESS LIST <br />REQUEST FORM <br />This is not a I.and Use .application and does nol initiate the revieiv ti»�eline mandated in .MN Stat. 15.99. <br />1. Property Owner Information: <br />Companyname: `�>`�jAD�GG I��vEZCP/�IEN ; LL-�. <br />Last name: S� � q p E G� First name: � A,� ; E� <br />Address: d2,,t S Q Q„� �, � po � �,u -� p,2 City/State/Zip: Sa u-r �a 5-r . PA u�. i'1 N � S(r� <br />Phone number: �,s �-,�q� _ q�3 3 Email address: o/s�� � c�le �s 4� sc/, n �( �. �c a- rn e� <br />� `o,�n <br />2. Applicant Information: (if different froin above) <br />Company name: <br />Last name: <br />Address: <br />Phone number: <br />First name: <br />City/State/Zip: <br />Email address: <br />3. Address(es) of Property Involved: (if d fferent from above) <br />2890-2920 Centre Pointe Drive <br />4. Purpose of Open House: ❑ Comprehensive Land Use Plan Map Change <br />❑ Planned Unit Development/Amendment <br />5. Description of Proposal: <br />Include adult day care as permitted use in the Centre Pointe PUD <br />■0 Interim Use <br />❑ Rezoning <br />6. Additional Information: Provide a sketch plan or site plan with this request form illustrating the <br />intended uses and their general placement on the property involved, along with any other <br />information that would be useful in the consideration of the project or use being proposed. <br />� <br />7. Signature: �Jl% �,Q�t,,. Date: � �7 /n a <br />