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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 <br />Special Use Permit $100 _ Division of Platted Lot <br />_ Vacation of Right -of -Way $100 Relocation of Dwelling $50 <br />Preliminary and Final Plat Variance to Zoning <br />$100 Minor Variance Ordinance $50 <br />Please complete form by t $25 <br />ovided <br />are insufficient, use additionalrsheets <br />item numbers: kprinting in ink. <br />eying information If the stocPr <br />theproper <br />1. <br />Name of Owner: 43N4`/ <br />�irst) (M die) *� <br />2 . (F.r(Last d (Phone) <br />Address of Owner: ,- <br />— / <br />Name Of °f Applicant: <br />4. As <br />Address of Applicant: <br />5. to It <br />Street Address ,,- P n-- <br />. and Street <br />First) (Middle) <br />®Vg <br />(No. and Street) <br />(City) v <br />(State) ( ip) <br />(Last) ...(Phone) <br />I <br />(city) <br />(State) (Zip) <br />-- �y ryuNerry Involved: <br />6. Complete Legal Description of Property Involved: <br />-------------- <br />7. Date Property Acquired: <br />$ • Present Ilse of Property: �/ �� <br />��--'.1e�_ Proposed Use of Pro <br />9. Present Zoning of Prorcrty. <br />Property: &A — <br />Proposed Zoning of Propert <br />10. What p an or ch n P y• <br />g makes this request necessary? <br />A <br />11. What is the expected effect of the propose <br />P ° erty v�lu s, health, sa e p r id change? (For example, on <br />° g, traffic condits, etc.) <br />t <br />