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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 <br />which <br />you are applying: <br />Rezoning <br />$100 <br />�_ Division of Platted Lot <br />$50 <br />Special Use Permit <br />$100 <br />$100 <br />_ Relocation of Dwelling <br />Variance to Zoning Ordinance <br />$50 <br />$50 <br />Vacation of Right -of -Way <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 <br />are insufficient, use additional sheets, keying information to the proper <br />item numbers:1. 2 '� .'� - <br />j <br />Name of Owner: (First) (Middle) (Last) (Phone) <br />2. <br />Address of Owner: (No. and Street) (City) (State) (Zip) <br />3. <br />Name of Applicant: (First) (Middle) (Last) (Phone) <br />4. <br />Address of Applicant: (No. and Street) (City) (State) (Zip) <br />5. C IQ ! Y- <br />Street Address of Property Involved: <br />6. Complete Legal Description of Property Involved: <br />7. Date Property Acquired: <br />8. Present Use of Property: Proposed Use of Property: <br />9. Present Zoning of Property: � _ Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />i Lam✓ �vt•�-��G7'�- �% 11�•�" Yl t�i' '�y' - <br />