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~~D~ .- CITY OF ROSEVILLE 2660 CIVIC CENTER DRIVE ROSEVILLE, MINNESOTA 55113 Please check item or items for which you are applying: RID Rezoning =x: Special Use Permit _ Vacation of Right-of-way _ Preliminary am Final Plat $750 $300 $200 $200 $500 _Canprehensive Plan Arnerrlment Division of Platted Lot == Relocation of DNell~ _ Variance to Zonirq ordinance Shoreline Permit $750 $100 $100 $200 $ 50 Please COITplete form by typirq or printiN;J in ink. If the spaces provided are insufficient, use additional sheets, keyirq information to proper item numbers: 5. 'Name of OWner: (First) (Middle)' 699 aJesr Chchf/TY fo/J2J ~-;;2 Address of OWner: (No. arx:l street) (City) c- -5/9' /lJtJ~/f ,4 SC/7L-1 b ,c= (Name of Applicant): (First) (Middle) SC/9 aJ. ~, t€d. .6-~ /?oSEt//c..L~ (Address of Appl.) : (No. arx:l street) (City) 599 te/. Lb. /?d 6-~ Street Address of Property Involved: 6. Complete legal Description of Property Involved: L/6 "c: (Last ) /f!bSGJ/I~LG' #A:/ S:-S1/3 (state) (Zip) &:;~- V.?~9d-b' (last) , (Phone) #d .:;;-:s-/,/'3 (state) (Zip) 1. 2. 3. 4. 7. rate Property Acquired: /;J - I 7 - ,,~ . Present Use of Property: /h t11 t>!eJ J 9. Present Zoning of Property: Proposed Use of Property: I Proposed Zoning of Property: 8. 10. Present camprehensive Plan Designation: Proposed Comprehensive Plan Designation: 11. What plan or charge makes this request necessaIY? 12'~', What is the expected effect of the proposed charge? (For exaxrple, on property values, health, safety, parkin:J, traffic con:titions, etc.) /\hAl~ . --------