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<br />~ <br /> <br />2660 CIVIC CENTER DRIVE <br />ROSEVILLE, MINNESOTA 55113 PHONE: 490-2279 FAX: 490-2931 <br /> <br />Please check item or items for which you are applying: <br /> <br />PUD <br />Rezoning <br />Conditional Use Permit <br />Vacation of Right-of-Way <br />Preliminary & Final Plat <br /> <br />$750 <br />$300 <br />$200 <br />$200 <br />$500 <br /> <br />-X- <br /> <br />Comprehensive Plan Amendment <br />Minor Subdivision <br />Relocation of Dwelling <br />Variance to Zoning Ordinance <br />Interim Use Permit - <br /> <br />$750 <br />$100 <br />$100 <br />$200 <br />$200 <br /> <br />When applying for more than one approval, only one fee (the highest) is charged. Please <br />complete form by typing or printing in ink. If the spaces provided are insufficient, use additional <br />sheets, keying information to the proper item numbers: <br /> <br />Name of Owner: <br /> <br />4~ <br />(First) <br /> <br />a,... <br />(Middle) <br /> <br />{~h' (Ph~e:t~ <br />'5'"'5"1 "3 <br />(Zip) <br /> <br />1. <br /> <br />Address of Owner: <br /> <br /> <br />2. <br /> <br />3. <br /> <br />Name of Applicant: (First) <br /> <br />(Middle) <br /> <br />(Last) <br /> <br />(Phone) <br /> <br />4. <br /> <br />Address of Appl.: <br /> <br />(No. And Street) <br /> <br />(City) <br /> <br />(State) <br /> <br />(Zip) <br /> <br />5. /;;l.3S- Il.AS~lJfWA/ Av~, uh <br />Street Address of Property Involved: <br /> <br />6. Complete Legal Description of Property Involved: <br /> <br />7. <br /> <br />Present Use of Property: <br />Proposed Use of Property: <br /> <br />8. <br /> <br />Present Zoning of Property: ~ <br />Proposed Zoning of Prop.: <br /> <br />9. Present Comprehensive Plan Designation: <br />Proposed Comprehensive Plan Designation: <br /> <br />10. What plan or change makes this request necessary? 'S.I9-LE tJ P pIlGPEA. rV <br />, <br /> <br />1 <br />