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CITY of ROSEVIUE <br />2660 Civic Center Drive <br />Roseville, minnesota 55113 <br />please check item or items for which you are applying: <br />pUD $750 <br />Rezoning $300 <br />Special Use Permit $200 <br />Vacation of Right -of -Way $200 <br />Preliminary and Final Plat $500 <br />$750 <br />$100 <br />$100 <br />$200 <br />$ 50 <br />Please complete form by typing or printing Jn :ink. If the spaces provided are <br />insufficient, use additional sheets, keying information to the proper item n Td,,- rs: <br />1'0 (Last) (Phone) <br />Name owner: (First) (Middle) <br />d L v�� a <br />2. �...� C� -— (State) (zip) <br />Address of Owner.. (No. and Street) (City) <br />3. <br />P;ar,�- of Applicant: (First) (jibe) (fit) (Phone) <br />4. <br />Address of Applicant:(No. and Street) (City) (State) (Zip) <br />Coperehensive Plan Amendment <br />Division of Platted Lot <br />Relocation of Dwelling <br />Variance to Zoning Ordinance <br />Shoreline Permit <br />5. <br />Street Address of Property Involved: <br />6. Complete Thal Description of Property Involved: <br />7. Date Property A aired: <br />8. Present Use of Property: O M, 9. Present Zoning of Property: <br />Proposed Use of Property: < ' ,.s = Proposed Zoning of Property: _ <br />10. Present Comprehensive Plan Designation: <br />Proposed Comprehensive Plan Designation: <br />11. What plan or change makes this request necessary? <br />12. What is the e>�ected effect of the proposed dm ge? (For example, on property <br />values, health, safety, parking, traffic conditions, etc.) <br />