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2660 CIVIC CENTER DRIVE ROSEVILLE, MINNESOTA 55113 PHONE: 490-2279 FAX: 490-2931 Please check item or items for which you are applying: PUD Rezoning Conditional Use Permit Vacation of Right-of-Way Preliminary & Final Plat $750 Comprehensive Plan Amendment $300 Minor Subdivision $200 Relocation of Dwelling $200 ~ Variance to Zoning Ordinance $500 Shoreline Permit $750 $100 $100 $200 $ 50 When applying for more than one approval, only one fee (the highest) is charged. Please complete form by typing or printing in ink. If the spaces provided are insufficient, use additional sheets, keying information to the proper item numbers: 1. ~et+ ~m~r $ndbe~l.hPl/!t-S-862 Name of Owner: (First) (Middle) (Last) (Phone) /7</,) H /111 (/,57i1- ;l~I'I/( 1'J1,1 ~-S-/13 Address of Owner: (No. And Street) (City) (State) (Zip) SAmE A5 o...'B-1Le Name of Applicant: (First) (Middle) 2. 3. (Last) (Phone) 4. SArY/<- Address of Appl.: (No. And Street) Srm~ Street Address of Property Involved: (City) (State) (Zip) 5. 6. Complete Legal Description of Property Involved: Jv~ i} D"i It' 5 Jo ~J IE K /1.1 2.$ S- F f aU- f # of (-Y.w RL tJ-t Lo_ 1__ . Present Use of Property: JI' ,,?It, fAm 8. Present Zoning of Property: Proposed Use of Property: ~1J11c. fi!rn Proposed Zoning of Prop.: t,...()f SfJ...--r Present Comprehensive Plan Designation: l. ~ Proposed Comprehensive Plan Designation: L.. ~ What plan or change makes this request necessary? ~ f h /5~ 5~t'f ...c;" }() ;J ~/(~/J /lfJfJrwC: a 6$)(/30' ~Y1d 0rXlfO' /l).rll' (ov'\.l-y /(LwKJ.s - ,",0 t c, 7. y 2. ~ - , 'f 2" ~l1 ~l4 s (/ rc... - lo f ,,)( ~ 1 7. f-\- . 9. 10.