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� gECIAL USE P�``iIT <br />'At. 3 CATIOIV �C?R. SPE PE,R: iIT <br />, . L'tdD THE ZONIPtG ORD �i���CE <br />VIL�.,11GE OF ROSEVILL�, �iINiJFSOTA <br />Fe e : 5 . 00 �`� ' ' -rt �-Z <br />� ase No.: � "�. <br />D��rections: �'ill out this f'orm in duplic�te by ttiping or <br />printing in ink. If the spaces provi.ded are insuzf'icient, <br />use additional sheets, kPying ini'ar•mation t� the proper <br />item number. <br />1. <br />� <br />Vame of pplicaniG� (Last) <br />� �'���-�_ <br />;��,cc�re: s nf Applicant: Iso. a:nd <br />:;� <br />..�.._ ._... <br />'; ; „ r�i�� af O�mer : <br />r---__ �P--Z c� .-�'�G <br />1a.. �lc:dr�ss of awnQr; <br />� � � � <br />� Street Address oi <br />e <br />• <br />J li <br />pex <br />.�-� ���-�' -� <br />Legal Description of' Pro <br />�r� <br />Present Zoning 17is�tric�: <br />9. P`resent�Use o <br />1 �- s <br />� <br />� �c <br />_ �-�- <br />street <br />1���. <br />rst <br />rst <br />i�outing e <br />T.D. Clerk <br />�idg. :Insp. <br />nttorney <br />Engineer <br />V . Admin . <br />�� i� <br />mi d dle <br />��.�� �� �� <br />cit;� and zone state <br />���G�y�- <br />middle <br />.�� ��=� <br />no and street city and zone <br />, �,� , -- <br />nvolved: <br />perty lnvolvea: <br />�.� <br />r op e.rtiy; <br />e <br />l0 s <br />Written statement �n proposec� usE of property. <br />Plan of proposed developme ._(5 copies) <br />�-a -c...-- �� � <br />,What will be the effect of he proposed use on <br />occupants of surrounding l.ands? <br />' w <br />��___- CL� v <br />. j�Phat 1 be the ei ect on sting <br />parking faci�_ities on ac� jacent streets? <br />. <br />state <br />, <br />�_ � <br />Goning Uralnanae �ectiion <br />Au�horizing Speci�l Permit: <br />�3.�30 <br />�.�i 5 <br />Proposed Use of Property <br />(2 copies) <br />e health, safety, and welfare <br />antici�ated traf'fic conditions, including <br />. What w�.11 be the ef'f'ect an property values in r,n� surrounaing az•ea: <br />� <br />� <br />1, Acknowledgment and Signature: The undersigned hereby represents upon all of the <br />penalties of law, for the purpose of inducing the Village of Roseville to take the <br />action herein requested, that all statements herein are true and that all worl� <br />herein: mentioned will be done in accordance z�.th the ordinances of the Village of <br />Roseville, and the laws of the State of ��linnesota _ <br />. �, � / � <br />Date -�' ��� � Signature - <br />