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v�F,'�'SA.�. L'SE PERI�iIT � <br />,;PPLI CA'I ION r�Qt� 3PECIAL PER`iIT <br />' j,TI�iDF,R '�lE ZONING O�.D�iJ��.JuE <br />UTLLAGE 0�' ROSEVILL�, i•SII�1'i'Jr.SOTA <br />� <br />Directions: Fill out this f'orm in duplicate by t��ping or <br />printzng in ink. If the spaces provided are insuf'ficient, <br />use additional sheets, keyin� ir�f'ormation to the proper <br />item number. <br />Fee: 5� .00 <br />a� se No. : <br />Routing: <br />I.D. Clerk <br />B�dg. Insp. <br />Attornev <br />Engineer <br />V. Admin. <br />1. Nam� o pp�icanc: as first yniddle <br />, I�c?dress of' pp laan :�iVo. and stre�t <br />city and zone <br />Y,� <br />"�'`-" �� � -"�� last first middle <br />.3 , .. i;1� O ei : <br />state <br />� 1leidr�ss of Owner: no and �tre�t city and zone state <br />. Stre�t A esswo��PrSperty 1.nvolved: <br />. Legal escr�.p on o roper y Involved: <br />7. Pres <br />9. Present Use ox� Yroper�cy: <br />11. <br />, �oning Ordinance �ection <br />Authorizing apecial Permit: <br />0. Propased Use <br />scrip�iori of Request: Teside�eae <br />Written statement ori proposed use of property. <br />P1an of proposed developrnent (� eopies) <br />(2 copies) <br />Property <br />��uhat will b� the effect of the proposed use orl the health, safety, and welfare of <br />occupants o� surroundin� lands? �� �dver�e effeat �atioip�t�c� ae ac.cee�+ ia <br />re�ie�e�aae <br />d oin�l�/ <br />. What will be the effecu on exis�cing and anticipated traf'fic conditions, including <br />parki_n� facilities on adjacen�t streets? �� p�ble� t�n�ioipated. �.� �deqt�ato <br />�ff at�ee�► p�rkis� w�ll be pravide�l And traffic orill ent�r �.nd e�it ��v■ <br />. <br />e <br />Date <br />What wi 1 be the effect on proper y values in th� surrounding area? <br />ABjaeent ��..luee �honld incre�.se �� prepe�°ty i� �Rr�in�2 �nd ��p�gr�ghy f� <br />_ e -. _ 7 �_ I��. �J r�1 s �N�e� 11f 7�0�� I7Bfli�a <br />Acknowledgment and Signature: The undersigned hereby represents upon all of the <br />penalties of law, for �ttle purpos� of inducing the Village of Roseville ta take the <br />action herein request�d, that all stiat�ments herein are true and that a11 work <br />herein mentioned will be done in accordance with the ordinances of the Village of <br />Rosevil�.e, and the laws of the S�;ate of I�linnesota <br />�lt�r�i� 26. 1968 ��� e�i"` i9• bgt <br />Si�nat e ,� its ,��Ct��a��r <br />