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<br />ot- <br /> <br />City of <br />R.I~ <br /> <br /> <br />Minnesota <br /> <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />2660 CIVIC CENTER DRIVE -ROSEVILLE, MINNESOTA 55113-PHONE: (651)490-2279-FAX: (651) .19{)-29:n <br /> <br />PAVEMENT MANAGEMENT PROGRAM <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013.05) Permit # <br /> <br />1. <br /> <br />fAUL (11, r /I/fJl'I~'I f/, <br />Name of Owner: (First) (MMdIe) <br /> <br />r5/J~5I<E <br />(Last.) <br /> <br />2. :; 9f?- 'WO ODAI<./pr;E sf, RO.5ev//-LE M;V, S-S//3 <br />Address of Owner: (No. And Street) (City) (State)) (Zip) <br /> <br />3. <br /> <br />6'>/--- Vg 3--:2:2- 90 <br /> <br />Owner Information: (Phone) <br /> <br />(Pax) <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 /> <br />R-1 <br />LDH <br /> <br />'tU <br /> <br />71~/a.~ <br />Lj/'"/o~79 <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 Oocuments\PA vats\! MA:--JAGE..ME:-"'1<f PERi\1IT.doc <br /> <br />Ova... <br /><:). <br />v\.'\: <br />