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i <br />a <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota 55113 <br />Please check item or items for <br />which <br />you are applyi..g: <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 <br />$100 <br />Minor Variance <br />$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 />1. <br />2. <br />Name of Owner: <br />(First) (Middle) <br />Address of Owner: (No. and Street) <br />3. U re <br />Name of Applicant: (First) <br />4. 97 4 <br />5. <br />6. <br />ress of Applicant: (No. <br />inar�e <br />(Middle) <br />oy e 44 <br />id Street) <br />ste,6 <br />(Last) <br />VY-13 �0 <br />(Phone <br />�z e rdk e Me gas-113 <br />(City) (State) (Zip) <br />OFS -7 h Alfy-1.3 qO <br />(City) <br />(Last) (Phone <br />State) (Zip) <br />6 vYt- UIt, . a 6.S',e r!1­4 e I v> <br />Street Address of Property Involved: <br />Complete Legal Description of Property Involved: ,Loj` 9, ,��OC 7� <br />�1JcJ �� ha, eL S�'rr»v�l Ac/d114-11jVase 1OWN-5 AAwWre, y <br />7. Date Property Acquired:/Y-16r-6- <br />8. Present Use of Property: o M Proposed Use of Property: fi6m e, <br />9. Present Zoning of Property: / Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? to '6011-.1 <br />ON 6 N Nt )f_t'h .Sll& e eel /llaA � <br />&U,gi ,Be c�oz) S eo my s /s,Avk I-r Nolfi o f <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />4/1 6G &Ig <br />