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CITY OF RCSFVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota 55113 <br />Please check item or items for <br />which you <br />are apply�_ng: <br />Rezoning <br />Special Use <br />Permit <br />$100 _ <br />Division of Platted Lot <br />$50 <br />_ Vacation of <br />Right -of -Way <br />$100 <br />$100 <br />Relocation of Dwelling <br />Preliminary <br />and Final Plat <br />— <br />$100 <br />Variance to Zoning Ordinance <br />$50 <br />Minor Variance <br />$25 <br />Please complete <br />are insufficient, <br />form by typing <br />use additional <br />or printing in ink. If the spaces <br />provided <br />item numbers: <br />sheets, <br />keying information to the <br />propr <br />proper <br />1. -�r71666 1AA IZ-C <br />J4 /V. <br />Name of Owner: <br />2. 1`-t6S A(n <br />Address of Gwneer <br />3. <br />Name of Applicant: <br />(First) (Middle) <br />(No. and Street) <br />(First) <br />(Middle) <br />Address of Applicant:�4� <br />(No. and Street) <br />5. 5 0 LC I <br />. <br />Street Address of Property Involved: <br />`t c) <br />(Phone) <br />n <br />(City) State) (Zip) <br />I A <br />(City) <br />Z <br />(Last) <br />I <br />(Phone) <br />u k 'L, �- <br />(State) <br />Zip) <br />6. Complete Legal Description of Property Involved: <br />k 1 D Cam. 8 4l <br />Z :5 ?V1 Ir <br />J <br />------------ <br />7. Date Property Acquired: ! 7 9 <br />8. Present Use of Property: In_,0,h Proposed Use of Property:y1� <br />9. Present Zoning of Property: __j_Q_�__ Proposed Zoning of Property: <br />10. What plan or change makes this request <br />necessary? <br />CSC' f?S7 <br />11. What is the expected effect of the <br />property values, health, safet proposed change? (For example, on <br />Y, parking, traffic conditions, etc.) <br />4,10/no s ' �• cam,: <br />%uses <br />