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<br />2660 CIVIC CENTER DRIVE
<br />ROSEVILLE, MINNESOTA 55113 PHONE: 490-2279 FAX: 490-2931
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<br />Please check item or items for which you are applying:
<br />
<br />When applying for more than one approval, only one fee (the highest) is charged. Please
<br />complete fonn by typing or printing in ink. If the spaces provided are insufficient, use additional
<br />sheets, keying infonnation to the proper item numbers:
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<br />1. ~ 5 G?v ,b.-t. He....'i# I ~ 5 fJ,,"^-TN~rt. J I (.. L C.
<br />Name of Owner: (First) (Middle)
<br />,. 2 S'"(P I IU. l/t'cn,1l. il't ST. t2. () ~-e t.I,'l'/tP, ,...N
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<br />2. 1. 34,. fL, 'co( ST. 5 w I~ "2 1(0 fl.f)~evd/~ wit)
<br />Address of Owner: (No. And Street) (City) (Stale)
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<br />Complete Legal Description of Property Involved:
<br />I . s~ e 11-7I1+c.. k WI .c,...;r
<br />~ SDIAn. ~'3 Fr ~ 1\)0'1.71- 10,,/.07 Fee.,.. ,,/=]1, G'lsr t..((..( !=eeT
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<br />7. Present Use of Property: C t.....;,..t.1.. ~,..,...., 8. Present Zoning of Property: a.:1 / c 1.......,.",,- I
<br />Proposed Use of Property: . C 1...\.I.rC.I.. f- Sc.,.,.16A;- Proposed Zoning of Prop.: f I.\. 0 I Ii
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<br />Present Comprehensive Plan Designation: I!
<br />Proposed Comprehensive Plan Designation: II
<br />
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<br />I
<br />I
<br />I
<br />I
<br />
<br />I
<br />II
<br />I
<br />I
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<br />
<br />PUD
<br />Rezoning
<br />Conditional Use Pennit
<br />Vacation of Right-of-Way
<br />Preliminary & Final Plat
<br />
<br />$750
<br />$300
<br />$200
<br />$200
<br />$500
<br />
<br />Comprehensive Plan Amendment
<br />Minor Subdivision
<br />Relocation of Dwelling
<br />Variance to Zoning Ordinance
<br />Interim Use Pennit
<br />
<br />5750
<br />S100
<br />S100
<br />S200
<br />S200
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<br />1.
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<br />2.
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<br />3.
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<br />Name of Applicant: (First)
<br />
<br />(Last)
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<br />( Phone)
<br />:,- ~ 113
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<br />4.
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<br />I7h() 1I.e
<br />(No. And Street)
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<br />5"5",,3
<br />(Zip)
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<br />(Middle)
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<br />(Last)
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<br />( Phone)
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<br />Address of Appl.:
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<br />I. 2S"(P , IV, 1/, G +,.11....... 57.
<br />;). )...~-S'J IV. VtCr--tt.l. 51".
<br />Street Address of Property Involved:
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<br />(Ci l})
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<br />(State)
<br />$"$'f" .3
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<br />(Zip)
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<br />6.
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<br />9.
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<br />,2 e>S.e vi 111" ~ 11,.._
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<br />What plan or change makes this request necessary?
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