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<br />P pfVl (...- ~ Tff' <br /> <br /> <br />Minnesota <br /> <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />2660 CIVIC CENTER DRIVE -ROSEVILLE, MINNESOTA 55113.PHONE: (651) 490-2279.FAX: (651) 490-2931 <br /> <br />PAVEMENT MANAGEMENT PROGRAM <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013.05) Permit # <br /> <br />1. <br /> <br /> <br />2. <br /> <br />.;/) . .~ {/' "I <br />c..J t () c7 cUz..,~ <br />Address of Owner: (No. <br /> <br />3. <br /> <br />((; j<-- / <br />Owner Information: (Phone) <br /> <br />Lj"cfy" /c;JP <br />(Pax) <br /> <br />(E-Mail) <br /> <br />4. <br /> <br />Applicant (if different):(Name) <br /> <br />(Address) <br /> <br />(Phone) . <br /> <br />5. <br /> <br />Street Address of Property Involved: <br /> <br />6. <br /> <br />a. Present Designation of Land: <br />b. Present Use of Property: <br /> <br />c. Zoning of Property: B-1 <br />d. Camp. Plan of Property: LDR <br /> <br />H <br />H <br /> <br />/~/~~ <br /> <br />(1 ~~y- 9' f <br /> <br />Date of Application Submission <br /> <br />APPROVED <br /> <br />NOT APPROVED <br /> <br />B: <br />Title: <br />D.R.C. Review Date: <br /> <br />B: <br />Title: <br />D.R.C. Review Date: <br /> <br />Date: <br /> <br />Date: <br /> <br />Q:\Planning Cammi5sion\Other Docuffients\PA VE.MENT MANAGE.ME.....rr PER!v1lT.doc <br /> <br />CACA., <br />'}/1f\-- <br />