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<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 /> <br />PAVEMENT MANAGEMENT PROGRAM <br />SETBACK PERMIT APPLICATION <br />(City Code Section 1013.05) Permit # <br /> <br />1. '~ 'f \<~~\NVV\. A:iAJe^~~ <br />Name of Owner: /7First) (Middle) (Last) <br /> <br />2. '?Dlt) \AJ. (')Ll~) ~~u~ R<'6Q>>!-\~ OOJu S~~ <br />Address afOwner: (No. And Street) (City) . (State) (Zip) <br /> <br />3. <br /> <br />(o~l <br />Owner Information: (Phone) <br /> <br />4/6& -/~ ~ ~ ~ <br />fF€8ij- <br /> <br />(E-Mail) <br /> <br />4. <br /> <br />Applicant (if different): (Name) <br /> <br />(Address) <br /> <br />(Phone) <br /> <br />5. ?f)i(j \,j)' CJw ot-M-r) 'f6\ \J J. <br />Street Address of Property Involved: <br /> <br />6. <br /> <br />a. Present Designation of Land: <br />b. Present Use of Property: <br /> <br />~~I.AYW <br />c. Zoning of Property: J.- <br />d. Compo Plan of Property: <br /> <br />7. Comments: <br /> <br />~~-/( ~'&lN1 <br /> <br />Ignature <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 />By: <br />Title: <br />D.R.C. Review Date: <br /> <br />Date: <br />