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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. D;ql1le / JtlI(f-huR- 3e-h) e.\ t-h't.(-\- <br />Name of Owner: (First) (Middle) (Last) <br /> <br />2. <br /> <br />;l..44l9 <br />Address of Owner: <br /> <br />:r= \<Z ~ V'\ L s+ <br />(No. And Street) (City) <br /> <br />~C~~ \f Ii I 'f/ rn N E;0113 <br />(State) (Zip) <br /> <br />3. <br /> <br />(p S t:_Jd ~ /- }~SS <br />Owner Information: (Phone) <br /> <br />(Fax) <br /> <br />(E-Mail) <br /> <br />4. <br /> <br />Applicant (if different): (Name) <br /> <br />(Address) <br /> <br />(Phone) <br /> <br />5. ~ LfLl to ~ (e~V) .e S-r <br />Street Address of Property Involved: <br /> <br />6. <br /> <br />~-- -. <br />a. Present Designation of Land: <br />b. Present Use of Property: <br /> <br />c. Zoning of Property: <br />d. Compo Plan of Property: <br /> <br />7. Comments:c-J)V2IUf w~ I S D K... w11ff N!;{jIf&1l tRS <br />J SIr t: /MJ '( Qu ~/"f)'-J 5. I f/tJ./Mt C A-LL If ~/ltf/- /I/JlL <br />11-1 tf~l{-770l). ~ N'e&(o?43'i? Tet-Al! ~1) <br /> <br /> <br />~{j.~ <br />Signature <br />5-~-()iJ <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 CornmissionlOther DocumentsIPA VEMENT MANAGEMENT PERMIT,doc <br />