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<br /> <br />Minnesota <br /> <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />2660 CIVIC CENTER DRIVE -ROSEVILLE, MINNESOTA 55113-PHONE: (651) 490-2279-FAX: (651) .190-2931 <br /> <br />PAVEMENT MANAGEMENT PROGRAM <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013.05) Permit # <br /> <br />1. AL YJ;J F 11) / E LEAl B ~r2 b <br />Name of Owner: (First) (Middle) (Last) <br />2. ? 0 b fn {' /J R. R /)/ (, TtJ)J C T R 65,E JJ j 1-1- E /0 AI S- J j 13 <br />Aadress of Owner: (No. And Street) J (City) (State) (Zip) <br /> <br />3. <br /> <br />~Sl 484-1.E)47 <br />Owner Information: (Phone) <br /> <br />191-8S4b <br />(Fax) <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 />R <br />R <br /> <br />c. Zoning of Property: R-] <br />d. Compo Plan of Property: LOR <br /> <br />aL 7f;L fLJDtj <br /> <br />Signature <br /> <br />rJJ:/- 7- I '?71 <br />Da e of Applic~tion Submission <br /> <br />APPROVED <br /> <br />NOT APPROVED <br /> <br />B: <br />Title: <br />D.R.C. Review Date: <br /> <br />Date: <br /> <br />B: <br />Title: <br />D.R.C. Review Date: <br /> <br />Date: <br /> <br />Q:\Planmng Commission\Other Document.s\PA VE.ME..'JT MA~AGE}.1E1\1' PER..\IIT.doc <br /> <br />\~~~ <br />~. <br />