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<br />'-.:, <br /> <br />4, <br /> <br />5. <br /> <br />6. <br /> <br />1. <br /> <br />2. <br /> <br />3. <br /> <br />CitY- of <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) -190-2931 <br /> <br />PAVEMENT MANAGEMENT PROGRAM <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013.05) Permit # <br /> <br />U<w Ifl:' <br /> <br />Name ofG er: (First) <br /> <br />:Jl.j) 7q ~rrrl 'Pit $1: ap5ev,}&,11/IJ :~-SJ1 ~ <br />Address of Owner : (No. And Street) (City) J(State) (Zip) <br /> <br />&5" J - <f2'-/~ S}/ <j ;(//1 Jh1ItJ.l.by gt11~j,A<OlIe, /f/~7 <br />Owner Information: (Phone) (Fax) (E-ivlail) <br /> <br />~ <br />itJ1ltS <br />(Middle) <br /> <br /> <br />Applicant (if different):(Name) <br /> <br />d(p 7~ A/f/I)rPA ,"')/: <br />Street Address of Property Involved: <br /> <br />(Address) (Phone) <br />a~v' I ne , fiJ.A/ S<5' 11.3 <br /> <br />, <br /> <br />a, Present Designation of Land: <br />b. Present Use of Property: <br /> <br />H <br />R <br /> <br />c. Zoning of Property: B-1 <br />d. Compo Plan of Property: LDR <br /> <br /> <br />31: /991 <br /> <br />APPROVED <br /> <br />NOT APPROVED <br /> <br /> <br />B: <br />Title: <br />D.R.C. Review Date: <br /> <br />Date: <br /> <br />Q:\Planning Commission\Other Documents\PA VE!\tE.\'T MA:\A(;EJ\1E~1 PERMIT.doc <br /> <br />\-of <br />'].7 <br />