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<br /> <br />Minnesota <br /> <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />2660 CIVIC CENTER DRIVE -ROSEVILLE, MINNESOTA 55113.PHONE: (651) 490-2279-FAX: (651) 490-2931 <br /> <br />PAVEMENT MAlVAGEMENT PROGRAM <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013.05) Permit # <br /> <br />1. <br /> <br />i? A Y 1'1 {9 AlO <br /> <br />Name of Owner: (First) <br /> <br />(; (j ~ 'R. r; G' <br />(Middle) <br /> <br />L r;-' S 5/'1 A II <br />(Las t:) <br /> <br />2. <br /> <br />.z 9Lf/ V/0008/(,IDG-t: <br />Address of Owner: (No. And Street) <br /> <br />IfDS~VI LL6 I'1IV ;;5'/J'3.. <. lf l'J. <br />(Oly) (State) (Zip) <br /> <br />3. <br /> <br />(PSI - i ~V -//z 7 <br />Owner Information: (Phone) (Fax) <br /> <br />(E-Mail) <br /> <br />4. <br /> <br />Applicant (if different):(Name) <br /> <br />(Address) <br /> <br />(Phone) <br /> <br />5. <br /> <br />Street Address of Property Involved: <br /> <br />6. <br /> <br />a. Present Designation of Land: <br />b. Present Use of Property: <br /> <br />R <br />R <br /> <br />c. Zoning of ProperLy: R-} <br />d. Compo Plan of Property: LDR <br /> <br />&-e~y-~ <br /> <br />Signa e <br /> <br />-y Z'it, I f9'? <br />ate 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 />B: <br />Title: <br />D.R.C. Review Date: <br /> <br />Date: <br /> <br />Q:\Planning Commisslon\Other Documenls\PA VEJ\1E:-"T ~1A~AGE~tE:-''T PERAIIT.doc <br />