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<br />i) 3/ZZ-- <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 />, A'fY\ \\L;- ~ I Ov~ (I <br />wner: (First) (Mjddle) <br /> <br />2qso ~oJbn' <br /> <br />Address of Owner: (No. An treet) <br /> <br />( Coe)( ) ~cg3~ b?a1 <br /> <br />Owner InformatlOn: (Phone) (Fax) <br /> <br /> <br /> <br />./'lAn. <br />(State) <br /> <br />So,{ <br />(Zip) <br /> <br />2. <br /> <br />3. <br /> <br />(E-Mail) <br /> <br />4. <br /> <br />Appbcant (ifdjfferent):(Name) <br /> <br />(Address) <br /> <br />(Phone) <br /> <br />5. <br /> <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-l <br />d. Compo Plan of Properly: LOR <br /> <br />~~-J:Q~ <br /> <br />Signature <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'IPlanning CnmmissionlOther Documen'slPA VEJ..tENT MANAGEJ..!ENT PERMIT.doc <br />