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<br /> <br />Minnesota <br /> <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />2660 CIVIC CENTER DRIVE -ROSEVILLE, MINNESOTA 55113-PHO:\'E: (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. <br /> <br />11) / E !-EN 8 b-.r2 b <br />(/liliddJe) (Last) <br />? {) b fo F f} R. R /)/G TO)) c T R65~ V j I-/..E 11.1;J <br />Aadress of Owner: (No. And Street) J (City) (State) (Zip) <br /> <br />At \//;J <br /> <br />Name of Owner: <br /> <br />F <br />(First) <br /> <br />3. <br /> <br />051 481-1.E)47 <br />Owner InformaUon: (Phone) <br /> <br />i <br />i <br />i <br />S-S/13 I <br />I <br />i <br />I <br />I <br /> <br />2. <br /> <br />4t91-854b <br />(Fax) <br /> <br />(EAvlail) <br /> <br />4, <br /> <br />Applicant (if djfferent):(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 />H <br />H <br /> <br />c. Zoning of Property: R-l <br />d. Compo Plan of Property: LOR <br /> <br />tliL- YM..R..}otj <br /> <br />Signature <br /> <br />f!J: '1 7- L'1?'1 <br /> <br />Da e of Application 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 CommI55jo~\Other Documents\P A VE.ME..'\tT MA:\A.GE..\tE.i\'T PER.\IIT.doc <br /> <br />/I p\; ~ <br />\J.(~ <br />