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<br />/J P .vI (...- ~ r If" <br /> <br /> <br />Minnesota <br /> <br />COMMUNITY DEVELOPME~T DEPARTj"JE~T <br />2660 CIVIC CE,",TER DRIVE -ROSEVILLE. MI,",,",ESOTA 55113.PHO,",E: (651) .I90-2279-FAX: (651) -1'10-2931 <br /> <br />PAVEMENT MANAGEMENT PROGRAM <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013.05) Permit # <br /> <br />Name of Owner: <br /> <br /> <br /><)!.- / / :] <br />(Zip) <br /> <br />1. <br /> <br />2. <br /> <br />,:] 't rf' d- <br /> <br />Address of Owner: <br /> <br />3. <br /> <br />6J~/ <br />Owner Information: (Phone) <br /> <br />i-Pi' /cJP <br />(Fax) <br /> <br />( E-IVlaiI) <br /> <br />4, <br /> <br />Applicant (if different):(Name) <br /> <br />(Address) <br /> <br />(Phone) <br /> <br />5, <br /> <br />Street Address of Property Invohred: <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-l <br />d. Comp, Plan of Property: LOB <br /> <br />/~.*~L <br /> <br />/ Signatur <br /> <br />-.1 -:l f - 7' Y <br /> <br />Date of Application Submission <br /> <br />APPROVED <br /> <br />NOT APPROVED <br /> <br />R: <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:\Plnnning Commlssion\Other DoclImt>nts\PA VEl\tE~T ~1A;\AGE..ME..'rr PER.,\ tlT.doc <br /> <br />f(;!f.:fJv fJ., <br />fj <br />