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<br />'. <br /> <br />... <br /> <br />~. <br /> <br />ern OF P.OSEVILLE <br />2660 CIVIC ~ DRIVE <br />RC)SEV1LLE. HIHNES<:n'A 55113 <br /> <br />14-tf-'Z3 -22 -~60't.- <br />Please cbedt item or items for 1r..Uich yw are ifA)lyjrg: <br /> <br />roo $750 ~Ehe!1sive Plan A1Enime!nt $750 <br />- PezoninJ $:WO -L... DivisiCft of Platted ~ $100 <br />== Special Use J!eJ:Bit $200 aelDc3tia1 of t).-11inJ $100 <br />_ Vac8't:1m oE Riqbt""'Of-tiay $2CO == Variance to 1.o!li.rq 0td:.i.Iwce $200 <br />_ PrelDdna1:y ant Final Plat $500 Sbaraline Pamit $ 50 <br /> <br />Please COIIpl~ fom b] typi.Jg or printin;J in ink.. If tbe ~ pr:orided are <br />insufficient. use adJitional sbEw-.As. keyiD;J inflAStica tI:' the proper itl!!ll. JdIt!els,;: <br /> <br />1. r"EiWl~ $ 'i ~I'J. a "-7 c- ~i (J r -I- ~:e.?-", 3 7 <br />Name of. aIDer: (r~) (Hi<<Ue) (last) (Rxaa) <br /> <br />770 u Co ,fJ.I! If()_(~ "LlIe: ;1'},J ...r.r;/~ <br />M1ress of 0Jner: (Mo. arrl street) (Cit}.) (St:ate) (Zip) <br /> <br />.y''l-'f~ J <br />(last) (R:Kne) <br /> <br />2.. <br /> <br />3. <br /> <br />4. <br /> <br />5.. <br /> <br />6. <br /> <br />7. <br /> <br />8. <br /> <br />- <br />10. <br /> <br />(J'J6"'~ E cSJ~,--I <br />(NmIe of ~iCant): (First) <br /> <br />(Middle) <br /> <br />.s~~ <br />(~ of }.J:pl.): (No. am Stn!et) <br />9 ~o w f!.o ~J 6 <br />stxuet ~ 0: Prupta-t.y Invol,,"E!d: <br />CDplete legal Dascriptia\ of Ptoperty Invnlwd: T.H-tfL-t ~ ~1L1'..1~,..~:j <br />_~ o.f""r.~()...i' Ai.,.s-t.. "A._~ __y (JAI. _:-I)" A"J <br /> <br />(City) <br /> <br />(Zip) <br /> <br />(St"..ate ) <br /> <br />Date Property ADquixed: ./ 1 ? ~ <br />Pxesen.t Use of Property:: A~~J-.l~ 9. ~ ~ ofOf~". ~::Z;.~JJ' <br />Proposed USe of~: 4-"..HiH>i.;J n~ -...."':t u~...., _____r. <br />Present. ~ve Plan Desi1Mt:.ion: <br />Prqx;Jsed ~ive Plan Des.i.gnatiu:: <br /> <br />11. <br /> <br />":-.a.~ t:~~-: = &.:i.~ nekes this reqt.-est ~ary? <br /> <br />.- <br /> <br />12. l-bat is t..~ eJq)eCtEd effect o~ the p...""CpO":.ed~? (Foe exanple, en plq:)erty <br />values. i':ealth. safety. p.lrlti.ng, tn.i!.:.; caxlit.ions: etc.} <br />_ Ni.:1A L. <br /> <br />-- <br />