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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 MANAGEMENT PROGRAM <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013.05) Permit # <br /> <br />1. <br /> <br />It fl foVj <br /> <br />Name of Owner: <br /> <br />2C-?j -*,hi1 srlfOSfr/.lf- ~ <br />Address of Owner: (No. And St eet:) (City) (State) <br /> <br />CSJ - Lft3-70S'{t <br /> <br />O,,'"ner Information: (Phone) - ( ax) <br /> <br />(First) <br /> <br />1'1- <br />(lvliddle) <br /> <br />f~tPlsO;1 <br />(Last.) <br /> <br />2. <br /> <br />S-jl/3 <br />(Zip) <br /> <br />3. <br /> <br />( E-tvlail) <br /> <br />4. <br /> <br />Applicant (if different):(Name) <br /> <br />. ~t# 5~/ ftf C/ 1/ / Jr- <br />Street Address of Property Involved: <br /> <br />(Address) <br /> <br />(Phone) <br /> <br />5. <br /> <br />51 <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 Property: R-1 <br />d. Compo Plan of Properly: LDH <br /> <br />----- <br />rkUi? '71- f~ <br /> <br />Signature <br /> <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:\PlanningCommission\Other Documents\PA Vf.J\tENT j\1A~:\GEME'\"T PERMIT.doc <br /> <br />C1\ .<1\.\ <br />~~ <br />