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e <br />��t� a. <br />�» ,�• �' � i <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 />SETBACK PERMIT APPLICATION <br />(CITY CODE SECTION 1013.05) <br />,- r <br />. fl <br />� �"' , -. - . . <br />: 0 RESIDENTIAL PROPERTY OWNER FEE -�-'�5- f� ���. <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, keying information to the proper item numbers: <br />1. <br />2. <br />3. <br />,�'unze of O►rner <br />/�iJi1�S � L. <br />.-�ddress of Oirrrer <br />'3�� � <br />.�rame of�pplicant <br />(First) (Middle) <br />(No. And St��eet) (City) <br />G% c.l>� S S C7 �� � J�l o <br />(First) (Middle) <br />(Last) (Phone) <br />(State) (Zip) <br />(Last) (Phone) <br />IIG�J -P I2 1 '� ' �`t � � �2 C� � I �l � G �� � G� <br />4. .-�ddress of.-��plicant: (No. And St�°eet) (City) (State) (Zip) <br />� <br />� �" � S C� ��rs � �3 I � . ,�s �� �'"�-,- /� �� <br />�. Sti•eet Addr-ess of Prope��ry Involved: � � <br />3L�� � C�w4S�S�� �� ��c� <br />6. State exactly what is intended to be done on or with the properry that �°equi�^es the setback <br />pe��init: <br />i f � '�=' ( ,J'� "� V�� W f J j�1� �.��I '�'1� ! � � �� ! % e� �? � Vd.. i� l i .(..P � ��t ,�, �_ � � t �, r/7 r_ w� . <br />/ <br />. � J ! i <br />�_ _ „ '!'+`�J� ,i��1�1 .1 !t � �N '✓L : J j. <br />�/ _ . <br />7. Er�larn alteri�ntii�es that have been examined which would enable you to meet existing Code <br />��equire»zei�ts: <br />� <br />Page 1 of 3 <br />