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<br />'-..... <br /> <br /> <br />Minnesota <br /> <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />2660 CIVIC CENTER DRIVE -ROSEVILLE, MINNESOTA 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 />1. <br /> <br />y PrtJG- \<OLlf\. <br />Name ofO\".'11er: (First) (Middle) <br /> <br />~ "Co n\ablh I~ose(/d(e r;N' <br />Address of Owner: (No. And Street) (City) (State) <br /> <br />1-D <br />(Last) <br /> <br />2. <br /> <br />~~If 3 <br />(Zip) <br /> <br />3. <br /> <br /> <br /> <br />o1-u- . c.CN"'\ <br /> <br />4. <br /> <br />AppUcant (if djfferenl;}:(Name) (Address) (Phone) <br /> <br />~~(,Co ma-tl\k S"f~t- ~ost.vil~t, P1,v S'~q7 <br />Street Address of Property Involved: I <br /> <br />5. <br /> <br />6. <br /> <br />a. Present Designation of Land: <br />b. Present Use of Property: <br /> <br />R <br />H <br /> <br />c. Zoninf-S of Property: H-l <br />d. Compo Plan of Property: LOB <br /> <br /> <br />Sig tur <br /> <br />, 3!?;>o /77 <br /> <br />Date of ApplJation Submission <br /> <br />B: <br />Title: P <br />D.R.C, Review Date: <br /> <br /> <br />APPROVED <br /> <br />NOT APPROVED <br /> <br />B: <br />Title: <br />D.R.C. Review Date: <br /> <br />Date: <br /> <br />Q:\PlanningCommission\Other Documents\P.J.. VEt.1E:\! MANAGEME....'T PERMIT.doc <br /> <br />rAC\ <br />'3 'J\) Y \.. <br />