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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 Division of Platted Lot $50 <br />Vacation of Right -of -Way $100 ... Relocation of Dwelling $50 <br />Preliminary and Final Plat $100 Variance to Zoning Ordinance $50 <br />_ -- <br />Please complete form by typing or printing in ink. Minor Variance $zs <br />If the i <br />spaces rov <br />use additional sheets, Dying information to the proper item numbers.ded are insufficier <br />Name of Owner: (First <br />(Middle) (Last) ; (Phone) <br />2. /�.79 �. moo. /Z,®, C /y//4 c.E�a�� <br />Address of Owner: (No, and Street) CCit <br />Y) (state) (Zip) <br />3. �/�TiLIG/< `v/�L/per <br />Name of Applicant : (First GOFF �-a5466 <br />(Middle) (Last) <br />(Phone) <br />4. /178' <br />Address of Applicant: <br />(No, and Street (City) (State) <br />(Zip) <br />S . FLrRIlJ4vOo� <br />Street Add ress• of Property Involved <br />6. Complete legal description of property involved: <br />7. Date Property Acquired: Z/ TV <br />8. Present Use of Property: pWG/pNT - <br />Proposed Use of Property;Q� G€,�•�5 <br />9. Present Zoning of Property; <br />Proposed Zoning of Property: � <br />10. What plan or change makes this request necessary? <br />11. What is the expected effect of the proposed change? <br />health, safety, g (For example, on property values; <br />y, parking, traffic conditions, etc.) ESe <br />Gvopur A�1DST 40 T/S�E .S/orHs,c /'YI S Gt/BGL f3 <br />