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�� SPE'�IAI, USE PF�''ffT <br />FnR SPEC� PERMIT <br />ApPLICATION <br />' UNI?ER � E ZON ING ORDI NANCE <br />VILLAf�E OF ROSEVILLE, i�NNES4TA <br />� <br />� <br />Dir�ctians: Fi t this torm 1�o�aea�are in�uificient, <br />printing in ink. Sf th� sFnceinp'ormation to the proper <br />use additional sheets, key g <br />item number. <br />S� � � � <br />�� <br />1. Name of Appl�-cant: Last <br />�/ �(v� r N . <br />2, �c;c�xesa of Applicant: <br />;�;;*i, � G / �,A � � 7�` <br />.:;�'_..., .yy , t7i� oft 0•,nmer : � <br />r �� <br />. ,--- , . � <br />0 <br />� <br />. <br />7• <br />dress of Qwner: <br />treet Address <br />Legal� esc� <br />��� � <br />iw� 'e- ✓� <br />Present Zoi <br />� i �fi� <br />�.,�,�- �-, L , ���-e <br />J � <br />ldo. and streot <br />ast <br />� <br />�--� G. ! �-�-�.. <br />no and street <br />operty Involvea: <br />�v � <br />�fir t <br />vL� <br />� <br />Fee : . 00 <br />� IQ�p�'"� �qd� � <br />ase No.: <br />Routing; <br />7,D, Clerk <br />Bldg. .nsp. <br />Attorney <br />Engineer <br />V . Admin . <br />� ,� <br />,.5� f - / � �.. <br />city and zone <br />.ddle ) <br />�� <br />state <br />middle ^— <br />._..�-f �.. /�-� � � �sta <br />cit.y and zone <br />�n of Property Znvolved: '' �- _�� 7� 7 <br />� �,�' • f' f, � S l,�J % �S c.G'f" ` � �rJ ;� `� <br />� Zoning Ordinance Section <br />Authorizing Special Permit: <br />��.i�� <br />�.. o . � 7 f ��'7� <br />� <br />-�y � .�..� �x���nt ,�; b�3 �i; <br />�n <br />ng+ Ihstrict: <br />b �. � v � e..r-� <br />9, p r esent Use of Prop�rty: <br />(� Ll cv �L A l� �"" ��� <br />1��3 <br />. <br />, Proposed Use of Pro erty <br />,� �� � t a p �. �. �� u�� d,�►�-� 2 <br />�- � r�'t' �1 e. A��S <br />. ve5cr�.ption of Request: ro erty, (2 copies) <br />Writt�n statement on proposed use of p P <br />P1.an of �roposed development (� copies) <br />y,ihat will be the effect of the proposed use on t� <br />� �ccupants of surrounding lands7 <br />__---- <br />e healt.h, safety, and welfare of <br />��� ��— - <br />, What will be �he <br />effect on existing and an ticipated traf'fic conditions, including <br />p��lr;� facilities on adjacent streets? <br />„ , �d � _ — <br />- ,� ��..- ., - <br />What will be the effect on property values in th� surrounding a"�a' <br />re resents upon all of the <br />L, Acknowledgment and Signature: The undnaucingdtherVbllage of Roseville to take the <br />penalties of law, for the purpose •f <br />uested �that all statements herein are truncesdofhthe�Village of <br />action hereln req � <br />herein mentioned will be done in a���o£ �nnesotathe or ina <br />�tose��'ille, and the laws of the Sta �. <br />� � '��--�s'� Signature <br />Date ��` <br />