Laserfiche WebLink
<br />. . . '"' <br /> <br /> <br />Minnesota <br /> <br />COMI\,WNITY DEVELOP,"IE~T J)EPf\RT,\IE~T <br />2660 CIVIC CE~TER DRIVE oROSEVILLE. MI:\:\ESO'f:\ 55113.NIO:\E: (651) -IYO-2279oF:\X: (6:>]) .190-29:~] <br /> <br />PAVEMENT MANAGEMENT PROGRAlvl <br />SETBACK PERMIT APPLICATION <br />(City Code Sec!:ionl013.05) Permit;; <br /> <br />1. <br /> <br />L.lt!:.' fhJ ~ N <br />,Vame of Owner: <br /> <br />(First) <br /> <br />/iLl3err <br />(,\1iddle) <br /> <br />..:5 -I- r u ~ 2- <br />(I.asl) <br /> <br />2. <br /> <br />~lb~() (YjAT/LDn S'r <br />Address of Owner: (Vo. And Street) <br /> <br />rr OS... e. I.J I L L..e. /J:J IJ/. <br />(Cily) (Slnle) <br /> <br />..:5- S I / 3 <br />(7ip) <br /> <br />'j <br />.J. <br /> <br />~ 6 ~/-::L ~~ 7 <br />Owner Informa!:iol1: (J1hone) (Fax) <br /> <br />(I:'-,\lail) <br /> <br />4. <br /> <br />Applicant (ifdifferent):(Vamc) <br /> <br />(.,\ d dress) <br /> <br />(J) J1(J II ei <br /> <br />5. d- Co ~ 0 fTY) A '7 I c n 11 S T <br />Street Address of Properly J t1\'ol\lcd: <br /> <br />6. <br /> <br />a. Present Designation of Land: <br />b. Present Use of Property: <br /> <br />H <br />H <br /> <br />c. Zoning of Property: H-] <br />d. Compo Plan of Properly: LDH <br /> <br />~t244 a ~~ <br /> <br />Signature 0 <br /> <br />7"-.0-- q 9 <br />Date of Application Submission <br /> <br />APPROVED <br /> <br />T <br /> <br />NOT APPROVED <br /> <br />--I <br /> <br />B: <br />Title: <br />D.R.C. Review Date: <br /> <br />Date: <br /> <br />Bv: <br />Title: <br />I D.R.C. Review Date: <br /> <br />Date: <br /> <br />Q:\PI:mmngCommlssion\Other Documents...PA \'E..\IE:-'T :-'1.-\:\AGE~1E:\T PER.\:!T.doc <br /> <br />tC .~~ <br />L-\ . -J <br />