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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 Pennit Vacation of Right-of-Way Preliminary & Final Plat $750 $300 $200 $200 $500 ~ Comprehensive Plan Amendment ~ Minor Subdivision Relocation of Dwelling Variance to Zoning Ordinance Interim Use Pennit $750' $100 $100 $200 $200 When applying for more than one approval, only one fee (the highest) is charged. Please complete fonn by typing or printing in ink. If the spaces provided are insufficient, use additional sheets, keying infonnation to the proper item numbers: 1. A.///Js ;vC Name of Owner: (First) (Middle) (Last) (Phone) 2. d07S NCI S.Jru/ck ~mrl//tLZ fit>> 5"s//3 Address of Owner: (No. And Street) (City) (State) (Zip) 3. /JAr L /-/4LVLR5vL ) Name of Applicant: (First) (Middle) (Last) (Phone) 4. dDC/te, ~tfy 5/ RDZV/aL /?1A1 Address of Appl.: (No. And Street) (City) (State) ~/J3 (Zip) 5. :J07~ do S~LLt.. /kJ4!; Street Address of Property Involved: 6. Complete Legal Description of Property Involved:A?1 Ac#~L:) 7. Present Use of Property: Proposed Use of Property: ~3 ~ 8. Present Zoning of Property: Proposed Zoning of Prop.: ~..3 J<3(n~~ 9. Present Comprehensive Plan Designation: ;8u/~JF.s~' Proposed Comprehensive Plan Designation: m~Qlv~ ,e~$~4JF v?" A L 10. What plan or change makes this request necessary? ~.L/r tJF7=" ~ ~Qv~L,L A}El~E,o 7a;e ~.?r/L.s5 ~~~~ , 1