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<br />~SIMbbE <br /> <br />I) <br />J <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 Z <br />$500 <br /> <br />Comprehensive Plan Amendment <br />Minor Subdivision <br />Relocation of Dwelling <br />Variance to Zoning Ordinance <br />Interim Use Pennit <br /> <br />5750 <br />5100 <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 />1. <br /> <br />:'"\ <br />!:jf.4t'e ~f mA'A <br />Name of Owner: (First) <br /> <br />De r/cJi ;'4.;' <br />(Last) (Phone) <br /> <br />B~ ;veq.'"f <br />(Middle) <br /> <br />2. <br /> <br />Address of Owner: (No. And Street) <br /> <br />(0 ty) <br /> <br />(State) <br /> <br />(Zip) <br /> <br />3. <br /> <br />7JJ A III i!j.) e <br />Name of Applicant: <br /> <br />/JO~/j,~A <br />(First) (Middle) <br /> <br />JIl,t..lJeh fllpp,. A/8Ji&9..37 <br />(Last) , (Phone) <br /> <br />4. <br /> <br />?O <Y <br />Address of Appl.: <br /> <br />U)Li-jr [tt WAlly /1('/ t <I IlbJiIJ.I;/Ii' 7/JJ) O.j-/lj <br />(No. And Street) , (City) (State) (Zip) <br /> <br />5, <br /> <br />q 61/ W81 t'.." .,db 11 ~ ~I <br />Street Address of Property Inv6/ved: <br /> <br />13 <br /> <br />6. Complete Legal Description of Property Involved: S l!. c (:i!'~f: .f.,~'c.J.lfl <br />"i- .5'(1I1L'~ v P,d f~d m.Lv /? 7..r <br />I ' <br /> <br />7. <br /> <br />Present Use of Property: <br />Proposed Use of Property: <br /> <br />iLK- <br />L8- <br /> <br />Present Zoning of Property: <br />Proposed Zoning of Prop.: <br /> <br />RI <br />f?1 <br /> <br />8. <br /> <br />9. <br /> <br />Present Comprehensive Plan Designation: <br />Proposed Comprehensive Plan Designation: <br /> <br />J 11 <br />J /1 <br /> <br />10. <br /> <br />What plan or change makes this request necessary? <br /> <br />J ..0/,,' r <br /> <br />- <br /> <br />A c.' t <br />