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a, <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota <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 Permit <br />$100 <br />Relocation of Dwelling <br />$50 <br />Vacation of Right -of -Way <br />$100 <br />Variance to Zoning Ordinance <br />$50 <br />Preliminary and Final Plat $100 <br />Minor Variance <br />$25 <br />Please complete form by typing <br />or printing in <br />ink. If the spaces provided are <br />insufficierl' <br />use additional sheets, keying <br />information to <br />the proper item numbers. <br />�. P cc- GE"i -,T-x <br />c. <br />Name of Owner: First <br />(Middle) (Last) ; <br />(Phone) <br />Address of Owner: (No, and <br />Street) <br />.(City) (State) <br />(Zip) <br />3. 5 PE <br />Name of <br />4. P o, <br />Address <br />Applicant: (First <br />�99Qa /-'-5. 4941 <br />Applicant: (No. and Street <br />5. �o27tQ ��r��cn�r <br />Street Address. of Property Involve <br />e) iLast <br />6. Complete legal description of property involved: <br />7. Date Property Acquired: <br />(City) (State <br />1 <br />8. Present Use of Property: ' Proposed Use of Property: <br />(Phone) <br />(Zip) <br />9. Present Zoning of Property: 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? (For example, on property values; <br />health safety, parking, traffic conditions, etc.) ZO(,)iN("2 L/"/A-,j(,tY &vjLt 42Zo64' <br />