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SPECIAL LSv PER�ffT <br />APFLI CR'I ION FnR SFE PER��TT <br />UP�I�E ZONIi�1G ORDI tialvCE <br />f <br />VILLAGE rJi�' ROSEVILLi:, i�fINTiESOTA <br />t� . <br />Fee : �5. 00 /� �C�Z 5� <br />Case No.: <br />� <br />Di�ections: Fill out this form in duplicat,e b,y typink� or <br />printing in ink. If the spaces provided are insuf'f'icient, <br />use additional sheets, keyi�g inf'ormation to the proper <br />item number. <br />1. Name of hpplicarit: <br />.�-�, �. lC <br />2. ^.c;dress of Applicar <br />:��� �r J <br />.R:k:..__ ...���� <br />.a ; ,;, i�l� pf Ciumer : <br />� ,� ( � -�-- �. <br />�J_E1�cl�ess o: <br />� <br />Own�r: <br />. �itreet Address <br />Last <br />� ��Vo. and s reet <br />p r �1 � c_ <br />rst <br />Routing: <br />I.D. Clerk <br />Bldg. In�p. <br />Attorney <br />Er.gineer _ _ <br />V. Admi.n. <br />dle <br />� c1Ly �nc� zone � � <br />1� l� �' Ili s � I I 1� <br />rst rr�-� d�le <br />� '� � ! � t �� <br />na and street clty a <br />, _JV1 � rv' v1� <br />operty Involved: <br />�..�� �/1�--��L��'��--e_.e�' <br />StGt@ <br />IUl , � �' �v <br />1... f"7 l9 Ir �' .� � <br />zone state <br />, - ...�� <br />� Legal Descript,ion of Proper�ty Involved: - <br />i���.�-�'�....�'�-� � - <br />7. Pre�ent Zonir�g L7istrict: . Goning Ordinance Section <br />Authorizing �pecial Permit: <br />Ol � � `�� � � '� <br />`P� � � � � � <br />� 10. Pro osed Use of Property <br />9. Present Use of Prop�rty: p <br />(�- j� r �j-��' <br />� �'_�,�t.,.�.��! ��t- . -X�-^'`''�'u-t 11. `�.e+-�-�-f �-« <br />11. Descriptian of Request: �` 3 , <br />Written statetnent on proposed use oF property. (2 copies) <br />Plan of proposed developmPnt (5 capies) <br />12. What will be the e.ffect of the proposed use on the health, safety, and welfare of <br />o�cupants of surrounding lands? <br />`ii " t1 �_._.�.-�t....e_�' ,Crd"���� <br />13. What will be tlie effect on existin� an� an <br />pa.xking facilities on ad,�acent streets? <br />�1/1,.0-�' �\ / ,� <br />ated traffic conditions, including <br />. What wi.11 be the ef'f'ect on property values �.r�t.n <br />� ,y <br />� � v <br />. <br />Date <br />� <br />e surrounding area? <br />Acknowled�m� and Signature: The undersigned hereby represents upon all of the <br />penalties.of law, for the purpose of inducing the Villa�� of Roseville to take �the <br />action hPrein requested, that all statements herein are t.rue and that all work <br />herein mention�d will be done in accordance with the ordinances of the Village of <br />Roseville� and the laws of the State of i�linnesota <br />. s-- � ,%� ���..c,�,�,� <br />� - � — .�-� � Signature ��"'"-' <br />