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u <br />�,Ip.� t�SE pER�uT <br />ApPL:TC�TZON �OR SPECrI�i 1 T <br />UNDER �I-iE 7,ONING OR�IIVAIdCE <br />VILL.AGE OF ROSEVILLE, i�ITI�dFSOTA <br />Fe e:� 5. �0 �'"�� a <br />�� , 1 � <br />� � Case�No.: <br />Directions� Fill out th�s f'orm in du�alicate by typing or <br />prin�in� in ink. If the spaces pravided ar� insuff�.ci�nt, <br />use additional sheets, keying inf'or. ma.i�ion to �the p.raper <br />item number. <br />�I�►���a�, Y,��a� <br />� Name Af Applicant: <br />2 , ,�c:?dx�� s of Applicant: <br />,,'+��� r�i�.,. '�f �{.li e��� <br />�3 . .. <br />.�.�Q�'��� <br />�, �r11.r�d�'ess of Uwner: <br />r���+� <br />s� <br />iVo. and street <br />st <br />����1 � ��s�,� a <br />no and stre�t <br />o �,� <br />. Street Address of Property Tnvo �ved: <br />s <br />st <br />Routing : <br />I.D. Clerk � <br />Bldg. Ins�. - — � <br />At�torn w�y <br />___— <br />Engineer <br />V. Admin. —�� <br />middle <br />city and zone state <br />cit.y and zon� <br />middle <br />state <br />��IS ���L'�� �ii��i f1�Pf <br />�o Le�al Descri.ption of Pr�perty Involved: <br />i 9. 14Aj <br />���t� � � �t+� . <br />'�. Present, Zoni_r�g D:is�;rict: . Zoni.n� Ordinance Section <br />Authori zi.ng Special Permit : <br />�"ri�mt��l i�eft� <br />Pre�ent Use of Propert�: <br />l�'gsper�y► �11 %� uo�d iar tl�e alio <br />„ Proposed TJse� of Prope�ty <br />an+� �aie af a��r a�►t��a�'bdl�s <br />11. ��escrip+�ion oi Requests <br />Written statement on proposed use of property, (2 copies) <br />�i���� a� <br />Plan of pr�oposed developrri�nt ( 5 copies}� 1'��t ���li��tbl�-Har�M�►11 A+iall paa� h��eetofore <br />_. .__a._- - ---__ ____a�.,M �_ ��...�.,.��.� r_e..�.�•_ a��rc�ved. <br />Wllcll� W11.1. vc vaac .,....�.v.. ., ...' --,�- r- -�- <br />oCcupants of surroundin� lands? <br />I�o a&�a�� <br />13. What will be the eff'ect on existing and an�ticipated tra.f'f'ic conditions, including <br />parking facil.ities on adjacent streets? <br />l�To c�e <br />. What <br />rt iro� �h++��in` Ce�ater <br />be the effect on propert�� values in <br />e �urrounding arEa <br />f�oa�r�l�� �• w�rke to iac���e� vsl�e nf prro�p�rt,r !a aurrouadin� a►r�a. <br />. <br />Date <br />Acknowledgment and Signature: The undersigned hereby repres�nts upon all of the <br />penal�ies of law, for the purpose of inducing the Village af Roseville to takE the <br />action herein requestad, that all statements herein are true and that all work <br />herein mention�d will be done in accordance wit��i the ordinances of e Village of <br />Roseville, and the laws of the State of I�linnesota � <br />. <br />Si�nature _ <br />