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sr v <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota <br />Please check item or items fcr which you are applying: <br />Rezoning <br />Special Use Permit <br />$100 <br />$100 <br />Division of Platted Lot <br />$50 <br />---� Vacation of Right -of -Way <br />$100 <br />Relocation of Dwelling <br />Variance to Zoning Ordinance <br />$50 <br />$50 <br />Preliminary and Final Plat <br />$100_ <br />Minor Variance <br />$25 <br />Please complete form by typing or printing in ink. If the spaces provided are insufficient, <br />use additional sheets, keying information to the proper item numbers. <br />1. <br />(� � ►4 � I., r �/ <br />�. �h w ,� N c ,�G� <br />' N,C <br />3 & -- <br />Name of Owner: (First) <br />(Middle) <br />(Last) <br />(Phone) <br />2. <br />2 q 9'� N, A t loN A <br />5-�- , RS CV ?� 1161 <br />4 <br />ri1 0 <br />SS" 1I 3 <br />Address of Owner: (No. and Street) (City) <br />(State) <br />(Zip) <br />3. <br />ij �� t—C <br />Name <br />i, t�� r�� e� ��'tiJC/•� <br />j� I <br />of Applicant: (First) <br />(Middle) <br />(Last) <br />(Phone) <br />4. <br />A ��, <br />oz,� . Ro,if u; <br />m �j <br />l <br />Address of Applicant: (No, and Street (City) <br />(State) <br />(Zip) <br />S. <br />Street Address of Property Involved <br />---- <br />6. <br />Complete legal description of <br />property involved: <br />7. Date Property Acquired: <br />8. Present Use of Property: 5,' ,,� �� , <br />-- ((,Proposed Use of Property; _ `j�_�'�'lF_' <br />9. Present Zoning of Property: Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? r i e Vt L <br />'Se- J oweUeJJ-v <br />r �i - _,t. D e F� t <br />1 lam% l�• O <br />_ d _ `U -FT_�`� <br />11. What is <br />health, <br />the expected effect of the proposed <br />safety, parking, traffic conditions, <br />change? <br />etc,)r.' <br />(For example, <br />on pro erty <br />values, <br />(,�� <br />