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<br /> <br />Minnesota <br /> <br />COMMUNITY DEVELOPME.'1T DEPARTME.'1T <br />2660 CIVIC CE~TER DRIVE .ROSEVILLE, MI:\':\'ESOT:\ 5.'>113.PHO:\'E: (651) .I90-2279.F.-\X: (651) .190-2931 <br /> <br />PAVEMENTMillVAGEMENTPROG~W <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013,05) Permit:; <br /> <br />1. <br /> <br />",viLLi Am / CARoL '~} <br />Name ofOw11er: I (First) <br /> <br />L YLEJ MA Y <br />(AI iddie) <br /> <br />L IN [)EiV A(L <br />(Last) <br /> <br />2. '3~o fY\APL~. LAN~ C', KDJeLJIt_Lf- t1,/\.) 5511?;:; <br />Address of Owner: (No. And Street) (City) (''';Iak) (7.ip) <br /> <br />3. <br /> <br />Co51 -If ~ 3.- LffC!O <br />Owner information: (Phone) <br /> <br />(Fax) <br /> <br />(/:'-'\/ail) <br /> <br />4. <br /> <br />A.pplicant (if djfferent:):(Name) <br /> <br />(Address) <br /> <br />(Phone) <br /> <br />5. 330 mA-PLf:. LA /VE: C! <br />Street Address of Property i 11 vo/\'ed: <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 Property: LDH <br /> <br />I ~( <br />d~~L'~____ <br /> <br />Signature <br /> <br />3 / .3 () / 97 <br /> <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 />Bv: <br />Title: <br />D.R.c.. Heview Date: <br /> <br />Date: <br /> <br />Q:\Plannwg Commlssion\Olher DoctJrnentsl.PA \'E..\IE~T ,\1:\.'\AGE,\1E.\T PEP.~UT.doc <br /> <br />~ 0 .fJvrJ\., <br />':y J <br />