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-�oV.g <br />�'6, //-2'1-�'q <br />CITY OF ROSEVILLE <br />2660 CIVIC CENTER DRIVE <br />ROSE'VILLE, MINNESOTA 55113 <br />Please check item or items for which you are applying: <br />PUD <br />$750 <br />Comprehensive Plan Amendment <br />$750 <br />Rezoning <br />$300 <br />Division of Platted Lot <br />$100 <br />Special Use Permit <br />$200 <br />-t_ Relocation of Dwelling <br />$100 <br />Vacation of Right -of -Way <br />$200 <br />Variance to Zoning Ordinance <br />$200 <br />Preliminary and Final Plat <br />$500 <br />Shoreline Permit <br />$ 50 <br />Please complete form by typing or printing in ink. If the spaces provided are <br />insufficient, use additional sheets, ]keying information to the proper item numbers•. <br />_ <br />'Mv t I P") CC A LI -7-q - -7 k4 C; F( ( WN <br />Name of Owner: (First) (Middle) <br />2. tStZ �,( C <br />Ac ress of Owner: (No. and Street) - (City) <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />10. <br />Wkk- <br />(Last) (Phone) <br />�scy lam.VI. mf� <br />(State) (Zip) <br />(Name of Applicant): (First) (Middle) <br />(Last) (Phone) <br />IS <br />(AddrF�s of Appl.): (No. and Street) (City) (State)UoLcl D:) <br />Street Address of Property Involved: <br />veq: <br />Date - Property Acquired: t p I3Q r{ '�v �`hc� S -Pcj (Q-ew,4V'Ut Sp'Wt(, f� \.S <br />� Cci��B.Sure�, Inc, <br />Present Use of Property: \tc ; n�tuhc( 9. Present Zoning of Property: <br />Proposed Use of Property: ; I i Proposed Zoning of Property: I 2- <br />Present Comprehensive Plan Designation: <br />Promised Comprehensive Plan Designation: <br />W71at plan or change makes this re est necessary? <br />'. I <br />r <br />12. What is the expected effect of the proposed change? (For example, on property <br />values, health, safety, parking, traffieditions, etc.) <br />1nc�i�tt5� �v e �u i 1 . / � 1►� � � 1�., -�11 `� �, -., � /. � ,,..,, .� i ,: <br />