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cTTY p f RaSEVUM o �� - <br />2650 Civic Center Drive <br />Pmseville, Minnesota 55113 <br />'Ply check item °r items for which you are apply: <br />PUD $750 <br />Rezoning $300 Comprehensive Plan Amendment $750 <br />Special Use Permit 200 Division of Platted Lot $100 <br />Vacation of Right -of -Way $200 - Relocation of Dwelling <br />Prep $500 Variance to Zoning $200 <br />Y and Final Plat - Shoreline Permit <br />$ 50 <br />Please OMplete form by il"sufficient, use additional � is � riming in ink.If the <br />spaces previded are <br />yinng infoiI.2.tion to the proper item numbers:1 • i7it2 l �Di 1,. e , <br />2. <br />3. <br />4. <br />5. <br />Name of Zbwner• <br />4 Cad <br />Address <br />of Owner: <br />0 <br />(FIXSt) <br />(Middle) <br />%Alw. aiu arreet) (City) <br />(mot) <br />M <br />(State) <br />Name of Applicant: (First) <br />(Middle) (fit) <br />Address of Applicant: <br />(No. and Street) (City) <br />(State) <br />Street Address <br />Of Property Involved: <br />Complete i,ega1, Description of <br />(Phone) <br />S�cl3 <br />(Zip) <br /><?4azZ <br />(Phone) <br />�l <br />(Zip) <br />'T-A <br />7. Date Property Acquired: <br />a. <br />�t Us <br />° Property: of <br />Of pre 9. Present Zoning Property: j <br />�r'ty. l'� may. . rU !r✓ <br />I!'v <br />v -Proposed Zoning of Property: -�-_ <br />10, Present Comprehensive Plan Designation: <br />Proposed Ccnprehensive Plan Designation: <br />11. What plan or chancre nnV c 4-1,'r <br />12. <br />What is the expected effect of the proposed <br />values, health, safety, par �Je' <br />parking, traffic conditi (For example, on Property <br />rns etc.) <br />5 <br />