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CITY OF ICSEV= <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 Pe=t $200 <br />Vacation of Right -of -Way $200 <br />Prelinina_ry and Final. Plat $500 <br />CScu prehensive Plan Amendment $750 <br />Division of Platted Lot $100 <br />Relocation of Dwelling $100 - <br />Variance to Zoning OrdixkUYce $200 <br />Shoreline Permit $ 50 <br />Please c=plete <br />form by typing or printing in ink. <br />If <br />the spaces provided are <br />insufficient, use <br />additional sheets, <br />keying information to <br />.the <br />proper item numbers: <br />I. <br />2. <br />3. <br />4. <br />C^l/v �f'l e5' 1f <br />III, <br />-Ile i <br />J 3 / /3 <br />Address of Owner: (No. and Street) <br />(City) <br />(State) <br />(Zip) <br />Name of Applicant: (First) (Middle) <br />(Last) <br />(Phone) <br />Address of App icanl t:(No. and Street) <br />(City) <br />(State) <br />(Zip) <br />Street Address of Property Involved: <br />6. Complete Legal,Desc=iption cif Property involved: <br />z. <br />7. Date Property A+: <br />8. - Present Use of Property: 0. Present Zoning 'of Property: <br />Proposed Use of Property: Proposed Zoning of Prop-erty: - <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 <br />the expects <br />effect of <br />the proposed change? (For example, on property <br />values, <br />health, <br />safety, parking, <br />traffic conditions, etc.) <br />