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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 />$100 <br />Division of Platted Lot <br />$50 <br />Special Use <br />Permit <br />$100 _— <br />Relocation of Dwelling <br />$50 <br />Vacation of <br />Right -of -Way <br />$100 <br />Variance to Zoning Ordinance $50 <br />_ Preliminary <br />and Final Plat <br />$100 >` <br />Minor Variance <br />$25 <br />Please complete <br />form -by typing or printing <br />in ink. If the spaces <br />provided <br />are insufficient, <br />item <br />use additional sheets, <br />keying information to the <br />proper <br />numbers: <br />2„ <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />Name of Owner: <br />ess of Owner: <br />_J Xvv^ e <br />ame of Applicant: <br />-Last <br />mij <br />( City) ( State, <br />(Last) <br />ress of Applicant: (No. and Street) (City) <br />First) (Middle) <br />(No. and Street <br />(First) <br />le) <br />(Phone) <br />(Zip) <br />„(Phone) <br />(State) (Zip) <br />Street Address of Property Involved: <br />Complete Legal Description of Property Involved: <br />V'-,Ne- e -;.ct I(-�n �. _-- _c, i ,'I. _ 1Z A n <br />Date Property Acquir.ipd : ..S - l _ <9 - <br />Present Use of Property: Proposed Use of Property: <br />Present Zoning of Property: Proposed Zoning of Property: <br />What plan or change makes this request necessary? Uj <br />1./1A,\III n, �1... .. 1,.1 .1 <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />