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r <br />40 <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota 55113 <br />Please check item or items for which you are applying: <br />— Rezoning <br />— Special Use <br />Permit <br />$100 _ Division of Platted Lot <br />$100 <br />$50 <br />„ Vacation of <br />Preliminary <br />Right -of -Way <br />_ Relocation of Dwelling $50 <br />$100 Variance to Zoning Ordinance $50 <br />_ <br />and Final Plat <br />$100 .Z Minor Variance <br />$25 <br />Please complete <br />are insufficient, <br />form by typing or printing in ink. If the spaces <br />use additional. sheets, keying <br />ded <br />item numbers: <br />information to thepr <br />proper <br />oper <br />j, , 1.S.Son <br />6�6 -6-17G <br />Name of Owner: (F rst) (Middle) (Last) <br />(Phone) <br />2. <br />QD <br />4-k `1��/eP� /�aS2✓�//� /%1✓J <br />aS"oS//�3 <br />Ad'erd ss of Owner: (No. and Street) (City) (State) (Zip) <br />3. <br />`-- <br />o�(Fi.rst � `� r's`��'� <br />��� �oS/7�, <br />Name of Applicant: (Middle) (Last) <br />(Phone) <br />4. <br />��n l i �or (��le(?/C2 �S�Ji//C. `'M <br />Address of Applicant: (No. and Street) (City) (State) (Zip) <br />5. <br />C�/,0/5 %)0rr`-:L b, h�*-,I er2-_ <br />Street Address of Property Involved! <br />6. <br />Complete Legal Description of Property Involved: <br />U 1- <br />o20 2/k 4Z. <br />9 e. 7'c..J 0o? 9 - R.G E a J -?Lk /o? - 2"J <br />SQJ, <br />D 16f G a7 3 <br />7. <br />Date Property <br />Acquired: <br />/7)fl?2'C�, /97l <br />8. <br />Present Use of <br />Property: <br />Proposed Use of Property: <br />9. Present Zoning of Property: Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />