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i <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota 55113 <br />Please check item or items for which you are applying: <br />_ Rezoning $100 <br />_,K Special Use Permit $100 <br />_ Vacation of Right -of -Way $100 <br />_ Preliminary and Final Plat $100 <br />Division of Platted Lot: $50 <br />Relocation of Dwelling $50 <br />_ Variance to Zoning Ordinance $50 <br />_ Minor Variance $25 <br />Please complete form by typing or printing in ink. If the spaces provided <br />are insufficient, use additional sheets, keying information to the proper <br />item numbers: <br />1. <br />Name of Owner: <br />Address of Owner: <br />3. <br />Name of Applicant: <br />4. <br />s <br />(First) <br />(Middle) <br />(No. and Street) <br />Address of Applicant: <br />5. 1�1 6 a-/l ) tL, .1 2—) (' -� <br />Street Addre <br />(Last <br />( City) <br />291- M74 <br />(Phone) <br />�!t4t 1n 5�1/1_� <br />(State) (Zip) <br />76:�f4 LL 5 <br />First) (Middle) (Last) <br />-- <br />(No. and Street) (City) <br />of Property Involved: <br />6. Complete Legal Description of Property Involved: <br />A jaAL� A A Z . F) -d .4 /i n.v <br />(Phone) <br />(State) (Zip) <br />b�53gSoa 6 2 4(-l6 <br />" <br />i. le Property Acquir�d: �s � /742(,3 ¢1776970 <br />8. Present Use of Property: Y&L A NTroposed Use of Property: )r <br />9. Present Zoning of Property: R__6 Proposed Zoning of Property: P,-(d <br />10. What plan or change makes this request necessary? S )?t T)a0e1_6F/n 6W-r <br />Cos ! <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />CVO <br />!N� fib <br />Pr �/k 04', <br />