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F <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota <br />Please check item or items for which you are applying: <br />Rezoning $100 <br />` Special Use Permit $100 <br />Vacation of Right -of -Way $100 <br />�Z 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 are insufficier <br />use additional sheets, keying information to the proper item numbers. <br />1. , L "(— b, (,AAA 90 <br />Name of Owner: (First (Middle) (Last) ,' (Phone) <br />Addressof Owner. (No. an <br />C. <br />3. <br />Name or Applicant: (First <br />4. 3h G a jayjA <br />Andress of Applicant: (No. <br />.5. l it fit <br />Street Address. of Property <br />Street <br />treet <br />nvolve <br />Gmo /dlklf A / <br />(City) (State) <br />Le) f Last) <br />ty <br />tate <br />6. Complete legal description of property involved: LQ YJ Q -L X4 <br />7. Date Property Acquired: <br />8. Present Use of Property: �_� Proposed Use of Property: <br />Zip <br />;Phone <br />S'Iflh <br />II <br />9. Present Zoning of Property: Proposed Zoning of Property: -_ <br />10. Wha plan or hange makes this request necessary? <br />11. What is the expected effect of the proposed change? (For example, on property values; <br />health, safety, parking, traffic conditions, etc.) <br />�6�,e <br />3 S eni if ra `�.� Le , rya. <br />