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SPEG7.�i. P�'�ffT <br />A�PLI.CATIdN FOit 5P� F'ER,"iIT <br />__��ND� q4iE ZOAi3NG �� Ai�CE <br />VIIdLAG� OF r�G�SE'JILLE, �•ffNiti�SR�� <br />� <br />'ll t this f�rm in du�l3cat.e by t��ing or <br />ree: �5.Q� <br />�ase tJnk : <br />R outing : <br />I,D. Clerk <br />Bldg. Insp. <br />Attorney <br />Engineer <br />V Admin. <br />I7irections : Fi ou . <br />printix�g in ink. If the spaces �rovide� are insuff �clent, <br />use addi�ional sheets, key�ng inf'ormation to tne pr�per <br />item number. <br />fir s t rni.ddle ; <br />1� ame f PP�� " <br />Last ` � <br />c� ,� � � state <br />�� . c ess of Applicar�t: No. and stree <br />city and zone <br />iir s.t middle <br />�� �Y�.m� of 4�er : <br />ast � ����� <br />• - -_..,;� � • , '% <br />,� city and zone state <br />adress of Qwner: no and street f {$r; <br />, � .. � � . � � a;: <br />� � Invol d: .5���d �' <br />Street Addres� of Property ��� ; ��� <br />. � .� `i <br />�j� , :. <br />� :.' " t Involved: ��� <br />'' yegal Descripta.on of Prop�r y <br />, f <br />, � � <br />� �, ;� <br />< , �-�� � . . � � � � �i <br />� , Zoning Ordinance Section �, <br />7. . Present Zonin� District: A,uthor5.zin� Special Permit: I <br />, <br />. �� � * <br />�,J �;,,,,�,,,r� 10. praposed Use of Propertv , <br />y, P�eseni Us� o� Propgriy: <br />��, <br />� <br />f( . �, � �a ; <br />y ._ � . . . . t4, <br />� t axt of Request:- � ' � ° ��� <br />_��_ lle " ��i ip + ro ased use af property'. (2 copies) � 4, ,; <br />Writter► sta�eme�t on p P `� <br />�; �o ies <br />,, gl�n of propos�d development (5 p � <br />1,]. e: the effec � of the proposed use on the hea.7.�h, safety, «ta�l welfare af <br />12., What wi lan�s? <br />occupants of surraur�di.ng <br />' fect on existing and anticivated traffic conditi ons, including � <br />' 13, 1�hat wi'1 ' be the ef <br />`� p�:�ng facil.i�ies on a�jacent streeis? <br />;� <br />Y values in t�e surrounding area? <br />1, LJhat will be the effect on praperty <br />re resents upon all of the� <br />3; Acknowledgment and Signature: The undersigned hereby P <br />� ur osc of inducing the Village o�' Roseville to take the <br />penalties of law, for the p p . <br />uested that all statements herein are true esd i the Vill�ge o� <br />actian here�n req � <br />herein mentianed will`ibeof thelStateaof Minnesotathe or n�nc <br />Roseville, an� �.`�e la..s � � <br />� / � � _j 5i ature � <br />, ; Dats � � <br />