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SP�CIAL USE P�ffT Fee :�5. �0 '� _��g��'
<br />, APPLICATION� �1?R SPECIAL PEF�` � Case No. : '
<br />' ' U�V�ER �iE ZOHING ORDINAhCE '
<br />ViLLAGE OF. ROSEVILLE, :�SNNESOTA Routing: � •�'�
<br />I.D. Clerk `F
<br />Bldg. Insp.
<br />Attorney
<br />Directions: Fill oui this form in duplicute by t��ping or Engineer
<br />printing in ink. If the spaces provided are insufficient, V. Admin.
<br />'us� additional sheets, keying information to the proper �
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<br />]..' Name of Applicant: L.ast first middle
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<br />� n` �,`�- 9. `�'resent :Use of Propert5r: 10. Pr�posed Use of Property ,� i���M�
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<br />�4 r 1�` � '. lr�`ritten. statement on proposed use of property, ( 2 copies ) ,��'�
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<br />� �P�.an. of 'proposed development (5 copies) �Y_ ,z
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<br />f� 1.; �What w�.11 be the sffec-� of the proposed u�e on the health, safety, and welfare' of � ;,r�;
<br />=1 � dccuparits cf, surraunding 'lands? `� ° �
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<br />��'". ; 13., What wi:ll be e efiect on eadsting and anticipated traffic conditions� including �`; ���'%
<br />`.�pa�king-facilities on adj ent streets? y�
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<br />;�. .� 1n1ha� will be; t effect on property values i�i t�he surrounding area? ,r;
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<br />�'' 1. .�ckn¢wledgment and gnature: The undersigned hereby represer_ts upon a11 af th� '., .;i
<br />; pen�l�ie� of law, for the purpose o� inducing the Village of RosevilZe to �ake the '
<br />' ac�ion herein requEsied, that a7.1 statements herein are true and �hat a11 work ' t'
<br />, herein men�i`aned w�i11, be dnne in accordance with the ordinances of the Village of �.
<br />, ' Ros.e v i 1 1e� an d t he �.aws of the State of M�.nnesota , `�`
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<br />{� �r Dat,a. �!� "";; � j'�,�..J�' Si ature �. �"<;.
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