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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 _ Division of Platted Lot $50 <br />Special Use Permit $100 _ Relocation of Dwelling $50 <br />Vacation of Right -of -Way $100 _ Variance to Zoning Ordinance $50 <br />Preliminary and Final Plat $100 _ 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. v�i /2l,,( A r 3 Fit ) P 1A nIA s� ( c� . t—y /-- /��' <br />Name of Owner: <br />2.5� /Xn <br />Address of Owner: <br />3. / S/ A4 C-C /jLs _ <br />/ Name of Applicant: <br />4. <br />5. <br />6. <br />( `irst ) (f4idd1e ) <br />2L) reaj �>-e <br />(No. and Street) <br />First) (Middle) <br />(City <br />Aaaress of A p-i-, fit: (No. and Street) (City) <br />0—,,, 7e� 16�9 <br />Street Ad ess'of roperty Involved:/ <br />Complete Legal Description of Property Involved: <br />(Last) (Phone <br />(State) (Zip <br />(Last) (Phone <br />(State) (Zip) <br />C Z-- <br />7. Date Property Acquired: C� <br />8. Present Use of Property: V Proposed Use of Property: SAME <br />9. Present Zoning of Property: - / Proposed Zoning of Property: .SrhM 1E <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 />