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I!C� � -# ai ztis <br />CrrY OF <br />2660 Civic Center Drive <br />Roseville, Kin esota 5513.3 <br />Please check item or items for which you are applying: <br />--- PUD <br />--- Rezoning <br />$750 <br />$300 <br />Comprehensive Plan Amendment <br />Z Division of Platted Lot <br />$750 <br />Social Use <br />Permit <br />$200 <br />Relocation of Dwelling <br />$100 <br />$100 <br />Vacation of <br />Preliminary <br />Right -of -Way <br />and Final Plat <br />$200 <br />$500 <br />Variance to Zoning onW%anoe <br />$200 <br />Shoreline Permit <br />$ .50 <br />Please complete form by typing or printing in ink. If the spaces provided <br />insufficient, use additional sheets, keying information to the <br />are <br />proper item numbers: <br />1. <br />oE3E?R-- r• t /Y/.4�PJi�Qi = �, <br />A!/06�301 <br />11- 9f7 <br />Name of Owner: (First) <br />(Middle) <br />(Tast) (phone) <br />2. <br />a77&�1���'s�!/� <br />_ <br />Address of Owner (No. and Street) <br />(City) <br />(State) (zip) <br />3. <br />Name of Applicant: (First) <br />(Middle) <br />(fit) (Phone) <br />4 . <br />Spa MF- <br />Address of Applicant:(No. and Street) <br />(City) <br />(State) (Zip) <br />5. <br />2 77 kL-Y/ <br />Street Address of Property Involved: <br />6. <br />C lete Legal Description of Property <br />Involved: /I-7,1A7- <br />PAR 7- Gt- <br />7. Date <br />8. Present Use of property:•I�w�.9. Present Zoning of Property: <br />Pmpa, ,.d Use of Property: << < < Prroposed Zoning may• of Pro • <br />�X-1- <br />10. Present Comprehensive Plan Designation:rsr <br />Proposed Comprehensive Plan Designation: � <br />11. What plan or change makes this request necessary? <br />12. What is the expected effect of the proposed change? (For example, on property <br />values, health, safety, parking, traffic conditions, etc.) <br />