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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) 490-2931 <br /> <br />PAVEMENT MANAGEMENT PROGRAM <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013.05) Permit # <br /> <br />1. <br /> <br />~---- .;Jet <br />\. Er, Ie <br />Name of Owner: <br /> <br />(First) <br /> <br />Jptlr! <br />(Middle) <br /> <br />/IJeYt l-bE A1 N' <br />(City) (State) <br /> <br />LgE/41~ <br />(Last) <br /> <br />2. <br /> <br />'293/ tkop8ttltJk or. <br />Address of Owner: (No. And Street) <br /> <br />.5.1'115 <br />(Zip) <br /> <br />3. <br /> <br />{0~1~ t/!L/-7t/iZ <br />Owner nformation: (Phone) <br /> <br />(Fax) <br /> <br />. /r//. /ese~~I4i-,"b'/},vl,c.,;., <br />~ . (E-Mail) v <br /> <br />4. <br /> <br />Applicant (if different):(Name) <br /> <br />(Address) <br /> <br />(Phone) <br /> <br />5. Z ~ 3 / W/)tJ!> !/JLtlJk J~ ;t1J.s~v/LL,E <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-1 <br />d. Compo Plan of Properly: LOR <br /> <br />90;1 JI <br />i6ZKre <br /> <br />~/'I A ~ <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 />B: <br />Title: <br />D.R.C. Review Date: <br /> <br />Date: <br /> <br />Q:\Planning Commission\Other Documents\P A VEJ\1E:'IT j\lA~\JAGE.ME.''T PER.\IIT.doc <br /> <br />~ <br />.A..- <br />'1' <br />