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a�'.� :, ; <br />�� �� <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />2660 CIVIC CENTER DRIVE <br />ROSEVILLE, MINNESOTA 55113 <br />PHONE: (651) 490-2279 FAX: (651) 490-2931 <br />(City Code is available on the Internet: www.ci.roseville.mn.us). <br />r +-: , __ <br />SETBACK PERMIT APPLICATION <br />(CITY CODE SECTION 1013.05) <br />r� ;.��� P�o�;�e.;t�- _._a. <br />0. RESIDENTIAL PROPERTY OWNER FEE -$-'15- <br />° (All fees payable upon submittal of completed application) ��"' ''�```�""� �� �`� <br />Please complete the application by typing or printing in ink. If the spaces provided are insufficient, use <br />additional sheets, keving informatiot_ to the nroner item numbers: <br />1. Name of O►t�ner: (First) (Middle) <br />`_ ,�,s�:� Cc c�a� h� ��, <br />2. Address of O�vner: (No. And Street) (City) <br />(Last) <br />(State) <br />(Phone) <br />G�5 / - �1�� z��o <br /><zip> <br />3 c� �� c� � s�S �,3 ��, a l��s ��,, C��, �ti 5��� �� <br />3. Name ofApplicant: (First) (Middle) (Last) (Phone) <br />i����-�' I2� � � �� <br />4. Address ofApplicant: (No. And St�°eet) (City) (State) (Zip) <br />� �0 3 S Ci i,�/�c SS CJ la' �� . , ��>�f' (,� r ��� ✓��'l✓ S � � <br />r <br />5. Street Add�•ess of P��ope��ty Involved: <br />��� � S C� �v r ss'�� �3 i��. <br />6. State exactly what is intended to be done on or with the property that requires the setback <br />pei�mit.• <br />, ,� <br />7. <br />�� � ; <br />� <br />� V 1 0 ►�G� � � � j��11,� <a" ''�1.�, G� ►� ► �C vUG(ec.� � ✓1 -;� ���.,; � t2^' ��_'°�_ � ��:� �:;', :�rr�, <br />bc�.c,k }:=. <br />Expluin alternatives that have been examined which would enable you to meet existing Code <br />requirements: <br />� <br />Page 1 of 3 <br />,� <br />