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<br />~-----... !:o <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 />G~ra, I d <br />Name of Owner: <br /> <br />(First) <br /> <br />Ch~57C::y. <br />(Middle) <br /> <br />/V7 t(,. f" L- J. <br />(Last) <br /> <br />2. <br /> <br />;).. l' tJ 7 ,A/. 57= A / ba 11 5 <br />Address of Owner: (No. And Street) <br /> <br />I-:JJev; it e. <br />(City) <br /> <br />.A.0 <br />(State) <br /> <br />~.,.. r/I~ <br />(Zip) <br /> <br />3. <br /> <br />tlS-l- .J/~J- .if~'I3 <br />Owner Information: (Phone) <br /> <br />(Fax) <br /> <br />uA.,//'1Lt....c..k @u....5 wefT: -<.Ie <br />(E-Mail) <br /> <br />4. <br /> <br />~nt~ <br />Applicant (if difJerent):(Name) <br /> <br />(Address) <br /> <br />(Phone) <br /> <br />5. <br /> <br />6. <br /> <br />Street Address of Property Involved: <br /> <br />a. Present Designation of Land: -Rv <br />b. Present Use of Property: .1:J)-~ eJe 4/'?;:.!;j <br /> <br /><;;. Zoning of Property: <br />d. Compo Plan of Property: <br /> <br />ILl <br />~~~,~ <br /> <br />7. Comments: p~.'v-(Lwa'y Wid' I'LL r 1#1 & ({ C-DVl Tj-A.r_ri.r_ a ~O">~ ti <br />rk~ $"'Lf.,h~""'~ /rI /97 -)1 A/~;1 hJ4Ie- ;;v..r-i. A/e-fA I,v$"' ;..- <br /> <br />('hJr. <br /> <br />-4~~J4 a~ ~__L_ <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 Commis.sionlOther DocumentsIPA VEMENT MANAGEMENT PERMIT,doc <br />