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<br /> <br />Minnesota <br /> <br />COMMUNITY DEVEI-OPMENT DEPAHTMENT <br />2660 CIVIC CENTER DRIVE -ROSEVILLE. MINNESOTA 55113.PHONE: (651) 490-2279-FAX: (65\) -\90-2931 <br /> <br />PAVEMENTMANAGEMENTPROG~~ <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013,05) Permit # <br /> <br />1. <br /> <br />/-/e fhJ~ N <br />Name of Owner: (First) <br /> <br />/-1 L 13 e r-r <br />(MjddJe) <br /> <br />..s -r,.. u r 2- <br />(Las/) <br /> <br />2. <br /> <br />a.b~O (YjAT/LOn-ST <br />Address of Owner: (No. And Street) <br /> <br />rr OS.. e- u i LL~ /Jj IJI. <br />(City) (State) <br /> <br />6'.s 1/3 <br />(Zip) <br /> <br />:). <br /> <br />cf ~ ~-:2 ~~7 <br />O..vner Informatjon: (Phone) (Pax) <br /> <br />(E-Mail) <br /> <br />4. <br /> <br />Apphcant (if djfferent):(Name) <br /> <br />(Address) <br /> <br />(Phone) <br /> <br />5. d- ro ~ 0 rn fJ 7 I L n II s: T <br />Street Address of Property Invo/\red: <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-1 <br />d. Compo Plan of Property: LOB <br /> <br />~tVH a #~ <br /> <br />Signature <br /> <br />7/"-.6"".... q 9 <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 />Date: <br /> <br />B: <br />Title: <br />D.R,C. Review Date: <br /> <br />Date: <br /> <br />Q,\PlanningComnllSsion\Other Documents\PA VEMENT MANAGE.\IENT PERMIT.doc <br /> <br />/.(\~ <br />'-A,j <br />