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c <br />r <br />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 Lot $50 <br />Special Use Permit $100 _ Relocation of Dwelling $50 <br />Vacation of Right -of -Way $100 _ Variance to Zoning Ordinance $50 <br />Preliminary and Final Plat $100 Minor Variance $25 <br />Please complete 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 />Name of Owner: (First) (Middle) (Last) (Phone) <br />2 . 01 C C A KiZC` AJ S EL. V�0 <br />3. <br />4. <br />5. <br />Address of Owner: (No. and Street) <br />Name of Applicant: (First) (Middle) <br />Address of Applicant: (No. and Street) <br />29�z Sl Inr C 4A a 0 1-IJ3 BLrV'6 <br />Street Address of Property Involved: <br />(City) (State) <br />(Last) _(Phone) <br />(City) (State) (Zip) <br />6. Complete Lega Description of Property Involved: <br />L.L.. W O) G A <br />LC> <br />F <br />7. Date Property Acquired: Fo <br />8. Present Use of Property: Proposed Use of Property: <br />9. Present Zoning of Property: Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? A WEIA) DEO:IA <br />EW'T (Zy W N 1 r_h wee I1 F nn— _r, � 7i rzv, 7.. _ — _ - <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety. nA rk-i nr <br />