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1���,, <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 />(C1TY CODE SECTION lO13.05) <br />❑ RESIDENTIAL PROPERTY OWNER FEE - $75 <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. Name of Owner: (First) (Middle) (Last) <br />. 'GS �pC� ,� �,` �, �, <br />2. Address of Owner: (No. And Street) (City) (State) <br />3 <br />3�� �u<c�r►��; ���� S ����P �,,��, <br />Name ofApplicant: (First) (Middle) <br />�JO -� , � L- , v� vl <br />�� <br />(Last) <br />(Phone) <br />�s�-y��-�S �-.� <br /><zip� <br />s-s�i� 3 - �5 �� � <br />(Phone) <br />���������� S�� � <br />4. Address of A plicant: (No. And Street) (City) (State) (Zip) <br />3 ! � i� � C � ✓�r�?� � �� � �� � �i �� e � � l� ���V �� I � j <br />5. Street Address of Properry Involved.• <br />3��S 1��� c�r►-u�S bl��� S <br />6. State exactly what is intended to be done on or with the property that requires the setback <br />permit: ( f�_ <br />�t/ r�(�-V' @ ; I�. ��0 S� � Z(' CI' T� �E r C�. <br />7. Explain alternatives that have been examirred which would enable you to meet existing Code <br />reguirements: <br />► <br />� <br />Page 1 of 3 <br />�� <br />