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<br />CitY- of <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 />(~t~ r+ <br /> <br />Z~5q ~/f:er sf <br />Address of Owner : (No. And Street) (City) <br /> <br />Name of Owner : <br /> <br />:::;~ <br />(AI iddJe) <br /> <br />reo.s 5 <br />(Last) <br /> <br />f<cs-evrll<:- I /YW SS 1/ '3 <br />(State) (Zip) <br /> <br />2. <br /> <br />3. <br /> <br />'51 - 48'-0 6q ~ <br />Ovmer Information: (Phone) (Fax) <br /> <br />(E-i'vla iJ) <br /> <br />4. <br /> <br />Applicant (if different):(Name) <br /> <br />(Address) <br /> <br />(Phone) <br /> <br />5. 'Z ~S"cr ~ {-I; ~f S.J- ~-tv/I(€ (1YhJ 3){l3 <br />Street Address of Property Involved: <br /> <br />6. <br /> <br />a. Present Designation of Land: <br />b. Present Use of Property: <br /> <br />/{ <br />/{ <br /> <br />c. Zoning of Properly: /{-1 <br />d. Compo Plan of Property: LD/{ <br /> <br />~~ <br /> <br />Signature <br /> <br />'~ <br />I ~ <br />. <br />, <br /> <br />41N~ <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. /{eview Date: <br /> <br />Date: <br /> <br />Q:\Planning Commission\Other Documents\PA VEME.:\rr j\1A,\i..\G E.M EST PERMIT.doc <br /> <br />v\AY\'-CZ~ <br />