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CITY OF ROSEVILLE 2660 CIVIC CENTER DlUVE ROSEVILLE, MINNESOTA 55113 Please check item or items for which you are applyirg: ? )t11 r J1..- ð/"Il) tjî/ 611 t~ RID -Rez . - omng _ Special Use Permit _ Vacation of Right-of-way _ Prelimi.na1:y am Final Plat $750 $300 $200 $200 $500 Cœprehensive Plan A1nerx3ment ~ Division of Platted Lot _ Relocation of Dwellirg Variance to Z~ ordinance - Shoreline Permi.t $750 $100 $100 $200 $ 50 Please c:::œplete form by typirg or prirItirq in ink. If the spaces provided are insufficient, use additional sheets, keyiDJ intomation to the proper item mnnbers: 1. J)f'o..\:-e. L \ A V\.à.~o-... b~"1"C¡t/ Name of OWner: (First) (Middle) (last) (Rlone) :;> 4 d. <.0 IV ' -H.ø-IN\. \ \ ~ ¡~9'!"~ llf V\1 '^- 55 II ~ Address of owner: (No. am street) (City) (state) (Zip) 1)(2 A~ L,.q \J~E"~O,v 6 3fc-7"''ILf (Name of Applicant): (First) (Middle) (last) (:Alone) ,;Jt.;) ~ .), t\~W'\,~ ~~¿vlt4 (\\V\ 5S113 (Address of Appl.) : (No. am street) (City) (state) (Zip) ~L£~(P µ, ~V1A\.l~ street Address of Property Involved: 2. 3. 4. 5. 6. Cœplete Legal Description of Property Involved: ~t (;) T I\. J-(j R...... ;¡.;, Lv J ~.c+ c4. ~ y~ i $ Yt/ e1 S w 'I" ...¡ Ale ~ ,... _'- 10 -r", )."/ _" ~3 7. Dite Property Acquired: /0"" 2&- 0., I 8. Present Use of Property: j(e~ 9. PresentZ01'lin:J of Property: Proposed Use of Property: ~~c;. Proposed Z~ of Property: 10. Present CCIIprehensive Plan Designation: Proposed CCIIprehensive Plan Designation: 11. What plan or ~e makes this request neoesS!ary? .J W L s.~ ~ dt~i. U lo+ +0 M.Ct.~ Q.. sec~.! btÅ~\Å..\V'-l ~i -k , 12. What is the expected effect of the prq:a;ed charge? (For exærple, on property values, health, safety, parJdn:J, traffic ocniitions, etc.)