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�,. � ;-_ __ <br />`, . <br />�� � <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.cixoseville.mn.us). <br />SETBACK PERMIT APPLICATION <br />(CITY CODE SECTION 1013.05) <br />v; �� Pe��- _ <br />0 RESIDENTIAL PROPERTY OWNER FEE -�-75- � <br />�` (All fees payable upon submittal of completed application) '�����" '��"�''`� '"p�`�� <br />Please complete the application by typing or printing in ink. If the spaces provided are insufficient, use <br />add�tional �eets, keying information to the proper item numbers: <br />1� Name of O►vner <br />(First) (Middle) <br />�� �' <br />(Last) <br />� <br />2. Add��ess of OK�ner: (No. And Street) (City) (State) <br />(Phone) <br />W 6s (,�f3 .2oob <br />�zlp� c 7 <br />375 ��tG, cs�ao !� 1� R�e� � ��� w�N .�s-'( /3 <br />3. Nan�e ofApplicant: (First) (Middle) (Last) (Phone) <br />L� <br />4. Add�•ess of Appl <br />� Go� <br />(No. And Sti�eet) <br />a� /� 6� �.- <br />5. St�•eet Addi•ess of P�•operry Involved: <br />6. <br />i <br />i� <br />(City) (State) (Zip) <br />State exactly what is intended to be done on or with the property that requires the setback <br />pe�°mit.• <br />`7 `a.�T�' � W � ;� 5l7 � l��/� i� � � �2a �n a � t_(Nti.,o ilZa,r r .�--r�� � � '"�l� D t� f �"D. <br />�L U 1' Gt �C �' s?? I�YT � �" `I itt� d YGt v'L .c., 1►'� `�1 Es �; � ,� % `� � .�^ --�— $ �,° ;�r'"; <br />7. Expluin alte�•natii�es that have been examined which would enable you to meet existing Code <br />requirements: <br />Page 1 of 3 <br />