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Sr�ECIAL � PER�'�ffT Fe e: �5 � 00
<br />,APPLICATION. �?R SPECIAI� P1�IT � a�e IVo.:
<br />`" U�ER 'IHE ZO�iING Qr�DIhAIvCE
<br />ii�LL11GE OF. R0.�'iEVILLE, �ffld���,SOTA Routing:
<br />. I.D. Clerk
<br />Bld�. Inso.
<br />�;. ALtorney
<br />- Di.rsctions: Fill out this iorm i: duplicat:� by t�ing or Engine�r
<br />, printing in ink. If the spaces provided ar�e ins�f iicient, V. Ac3mim. -
<br />- us� adclitional sheets, keying iniormation i;o Lhe proper
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<br />: item number.
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<br />1 N e of Applicant: I�ast� first middle
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<br />,;- 2. �t�dress oi' App1icant: ido. and street, city and zo� e/ state
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<br />;�'.. ��dd�e�s of awn�r: no and street city and zone s te ```
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<br />�,,, . Stxeet , Address of Prope Involved:
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<br />""�"` � S ; Legal Descr�:p on o roperty Involv
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<br />U:� s� �,' :'7 p s�nt 2oning District: . 2aning Ordinance Section. ,`,
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<br />a`,��r Authorizing Specia2 Permit: �,,
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<br />�. `;Pxesent tJse; of F'rope.'cty: ; 10,. Pro�osed Use af Prnper�y ' � �
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<br />, �; il:''' Description of Request: ,` f���
<br />�`` "`W�it�tsn state!nent r� proposed use of proper�ty. (2 copies) ` �r�
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<br />�;� ` Plan of.proppsed de�elopment (5 copiss) �
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<br />�,, . Ti�hat wi1:1 be �he :Fffect af the 'prApose use on the-heal.th, �safeiy, and -welf�re ,:of,� ,,�
<br />�:f' ' nec.upants of surrounding lands? ;x'`
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<br />�,�°, ' Wh�t will be' t effe on existing and anticipated. traffic eonditionsy ine].uding y�`
<br />' park�.ng , facilities on- adjacent stree�s? �y -
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<br />' l,,;; What will be the effect on property values in ihe surraunding area? '
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<br />Gs�.�At � d�f ia• o��•'� c.�r%/� G �,
<br />1,' A:cknowledgment �.d ignaturs; -The undexsignect h�xebyr represents; upon ; all 'of the �
<br />" penaltie� of lawa or the pu�poss of inducing the Village of ftoseville to:take �he,:
<br />action h�rein r�quested9 thai all statements herein are true and -�h�t all work - ,
<br />'' lae�'ei.n mentioned wi11 oe don� in accord�,nce with the ordinances o� ths Vill � e af �-z
<br />_ R��evilJ:�, . and the laws of the �S�2te of ��iinnesota ; r, :�� .. _
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<br />Da�e ,.� . ���:. �� Signa� �"` `
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