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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 LCt $50 <br />_ Special Use Permit $100 Relocation of Dwelling $50 <br />Vacation of Right -of -Way $100 _v"Variance to Zoning Ordinance $50 <br />Preliminary and Final Plat $100 Minor Variance $25 <br />Please compete 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. <br />2. <br />3. <br />0 M nv-- rs C-.-I+ 3 7J/- / 7 / y <br />Name of Owner: (First) (Middle) (Last) (Phone) <br />'�5D 67i-c'V lao- . t11vlc a.._ S M N 'S 5 `r-03 <br />Address of Owner: (No. and Street) I (City) (State) (Zip) <br />*dame of Applicant: (First) (Middle) <br />(Last) <br />(Phone) <br />4. ►n <br />Address of Applicant: (No. and Street) (City) (State) (Zip) <br />5. �� o - � , �-f I eo lP�l <br />Street Address of Property Involved: <br />6. Complete Legal Description of Property Involved: <br />r . , I I _ ..L. 4- -1-, h F rc r, l a -H r, -( 4 5 ,l. -H-S 1 a ri c ( a- <br />7 . Date Property Acquired: <br />vac Ce 2fi <br />8. Present Use of Property: Proposed Use of Property: Set n1 6, <br />9. Present Zoning of Property: Proposed Zoning of Property: <br />10. What plan or change.makes this request necessary? /I <br />I n A „ -1-< r 1 F �_ i �^ s D jy1rt L--1'r- /Yl r.*)� t-- t C( f 2. T- US. <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />