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~113 D11:J"qc) 01;;,tcrS CITY OF ROSEVILLE 2660 CIVIC CENTER DRIVE ROSEVILLE, MINNESOTA 55113 Please check item or items for which you are applying: PUD $750 - Rezoning $300 == Special Use Permit $200 --X..- vacation of Right-of-Way $200 _ Preliminary ani Final Plat $500 _ COO1prehensive Plan ArnerrlItY=nt $750 Division of Platted lot $100 == Relocation of IMelling $100 _ Variance to zoning OIdinance $200 Shoreline Permit $ 50 Please complete form by typinI or printin;J in ink. If the spaces provided are insufficient, use additional sheets, keying information 'to the proper item numbers: 2. ~73i NO, t:AlfelJ/€W Address of OWner: (No. arrl street) oS T, Pl-'JlJL (City) ~33.. .sf) S () (last) (Phone) J11N. 6$1/3,- /372- (state) (Zip) 1. mt!. GouSH {!o)/67. C/J ~ Name of OWner: (First) (Middle) 3. (Name of Applicant): (First) (Middle) (last) (Phone) 4. (Address of Appl.) : (No. am street) (City) (state) (Zip) 5. street Address of Property Involved: 6. Corrplete legal Description of Property Involved: S 1$)V OF THe S W)Y t'J 7= S 6C:rl ()AJ LJ. T 2'1 AI J? 2.~ W ~.x t:!S PT 7~JE wr=s:r 9:g ..I;'" Ffrl: f)'J ;t: :'j:":tJ-~;;:.fs" o1jF'jI6,p~~BT&.T T~ 1=AIPfJI6ttJ 7. Date Property Acquired: 1 q, 7 9. Present zoning of Property: Proposed Zoning of Property: 8. Present Use of Property: Proposed Use of Property: 10. Present Conprehensive Plan Designation: Proposed Corrprehensive plan Designation: 11. What plan or d1ange makes this request necessary? --All) 7 N~Dcb- f"AO ~A~EA)T 12. What is the expected effect of the proposed change? (For example,' on property values, health, safety, parking, traffic oon1itions, etc.)