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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 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 are insufficient, <br />use additional sheets, keying information to the proper item numbers. <br />1' (Phone) <br />Name .of Owner: (First)(Middle) (Last) <br />2•State Zi <br />Address of Owner: (No. a d Street) (City) L I ( ) ( p) <br />3. (Phone) <br />Name o.f Applicant : (First) (Middle) (L st ) <br />4. 9 A% . C d 011 i /P,l .� /-Te✓•`L L P Y,�'I i/I• <br />/� (City) State (Zip) <br />Address of Applicant: (N . an Street ( y) ( ) <br />113 <br />Street -Address of Property nvolved <br />6. Complete legal description of property involved:] y© a P <br />7. Date Property Acquired: F 1�6, ??/33 <br />8. Present Use of Property: l �5��d Proposed Use of Property: / ��h� e3 /111a�, <br />9. Present Zonin-g of Property: /1 l Proposed Zoning of Property: <br />10. What plan or change makes this request necess rY? v, ✓ '� <br />�, 6 U e- r v 1 t t a' ✓r •e i S <br />�,� { ✓ d 4d ,-S -✓ . o r � <br />lelv <br />ep <br />11. What is the expected effect of e proposed change? (For example, on property <br />health, safety, parking, traffic conditions, etc.) LJ Yi F� <br />I <br />