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<br />I' <br /> <br />JI <br /> <br />( <br /> <br /> <br />Minnesota <br /> <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />2660 CIVIC CENTER DRIVE -ROSEVILLE, MINNESOT A 55113-PHONE: (651) 490-2279-FAX: (651) 49()-2931 <br /> <br />PAVEMENT MANAGEMENT PROGRAM <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013,05) Permit # <br /> <br />1. <br /> <br />~I.{ I tJ.. (C\~l~_~ t <br />Name of Owner: (First) <br /> <br />2. <br /> <br />2- (p >Co <br />Address of Owner: <br /> <br />Co "- l ~-,; R V <;. f- <br />(No. And Street:) <br /> <br />-K'u y-~' S <br />(MMdJe) <br />eOS~ V/ j l~ <br />(."'tate) <br /> <br />(Last) <br /> <br />(City) <br /> <br />(Y\(0 ~/13 <br />(Zip) <br /> <br />3. <br /> <br />381--~1 ~ <br />Owner InformaUon: (Phone) <br /> <br />(Fax) <br /> <br />(E-iv/ail) <br /> <br />4. <br /> <br />AppJjcant (if djfferent):(Name) <br /> <br />'7...(p S-lo G a. I 4-; ~ V- <br />Street Address of Property Involved: <br /> <br />(Address) <br />/Zo ~t vi II~ <br /> <br />(Phone) <br /> <br />5. <br /> <br />In 0 c;:s II 3 <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 Properly: B-1 <br />d. Camp. Plan of ProperLy: LDH <br /> <br />~~ <br /> <br />Signature <br /> <br />3/~,Jqq <br /> <br />Date of Application Submission <br /> <br />B: <br />Title: <br />D.R.C. Review Date: <br /> <br /> <br />NOT APPROVED <br /> <br />Date: <br /> <br />Q:\PIRnningCommlssion\Ol.her DOC\lment~\P:\ VE..\tEST ~lA:\AGE.J\1Ej\1 PERJ\IIT.doc <br /> <br />(Jv fJ\. <br />3j~V <br />