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<br />. . <br /> <br />City of <br />~~ <br /> <br /> <br />Minnesota <br /> <br />COM!\-IU~ITY DEVELOPME~T DEPARTME~T <br />2660 CIVIC CE:\TER DRIVE oR05EVILLE. \11:\:\E501'.\ 55113.PIIO:\E: (651) -190-2279oF:\X: (651) -llJ()-2'H I <br /> <br />PAVEMENTMillVAGEMENTPROG~W <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013.05) Permit # <br /> <br />1. <br /> <br />b0 \f! ~e..5 '~\.I <br />Name of Owner: (Pirst) <br /> <br />%\ Cl ~ ~ co) f"d <br />(Middle) <br /> <br />(LUSI) <br /> <br />2. <br /> <br />~90 I <br />Address of Owner: <br /> <br /> <br />:=, - J... Ii I V: <br /> <br />'J <br />,J. <br /> <br />Lo51-if~i- ~'lS':'; <br />Owner / n forma !:iOIl: (Pholle) <br /> <br />(Fax) <br /> <br />(E-,\luil) <br /> <br />4, <br /> <br />Applicant (ifdifferent):(Name) <br /> <br />(Add ress) <br /> <br />(Plwlle) <br /> <br />VI . 'Q-- <br />5. -..:::>< <a 0 \ \'<\ d r' i e. \I ~ t r ~(~- l <br />Street Address of Property /IIHJ1Ired: <br /> <br />6. <br /> <br />a. Present Designation of Land: <br />b. Present Use of Proper!:y: <br /> <br />Ii <br />Ii <br /> <br />c. Zoning or Proper!:y: H-l <br />d. Compo Plan of Proper!:y: LDIi <br /> <br />c~~ ~~. " <br />~I;.,~\.~ . ~~0L <br />Signature <br /> <br />~~~\ ~C\.~ <br />Date of A plicati n SubnllsSlon <br /> <br />APPROVED <br /> <br />NOT APPROVED <br /> <br />B: <br />Title: Date: <br />D.R.C. Review Date: <br /> <br />Bv: <br />Title: <br />D.R.C. Review Date: <br /> <br />Date: <br /> <br />Q:\Plannlng Commlssion\Other Documenrs .PA \'E..\1E.\T ~1:\:\:\.GE,\1E;\T PEP.~IIT.do(' <br /> <br />i <br />I <br />\ _ c.... Q) II <br />>') <br /> <br />, <br />