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<br /> <br />Minnesota <br /> <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />2660 CIVIC CENTER DRIVE -ROSEVILLE, MINNESOTA 55113-PHONE: (651) 49G-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 />tVI )//(.( hz <br />(Middle) <br /> <br />9{lC}/} kJaJ/;~y SI M?yt/I)/~ <br />Address of Owner: (No. And Street) (Citv) <br />4-g""3 - -;3 i /.f)- . <br />(y/l-l1-r;3-1/392 U/) -R5~-.'3~7 J <br />Owner Information: (Phone) (Fax) <br /> <br />GiJfr.1C" <br /> <br />Name of 0 er: <br /> <br />(First) <br /> <br />7--rs> Y! c/c 1/ <br />(Last) <br /> <br />2. <br /> <br />/J(11/ <br />(State) <br /> <br />.~s-/) 3 <br />(Zip) <br /> <br />h <br />3.\\). <br /> <br />(E-Mail) <br /> <br />4. <br /> <br />Applicant (if djfferent}:(Name) <br /> <br />(Address) <br /> <br />(Phone) <br /> <br />5. .:J. (/ Cj D ~ /1/ c r" <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-l <br />d. Compo Plan of Property: LDR <br /> <br />~ <br />J 1 _ <br />!'.,. .:.;t~~ <br />51 <br /> <br />)) ~ 99 <br /> <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:\PlanningCommission\Other Documents\PA YEMENT MANAGEMENT PERMIT.doc <br /> <br />(;\0\ <br />--Av J.9 ' <br />