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1 <br />i <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 $100 )4 DivisionPlatted Lot $50 <br />Special Use Permit $100 i 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. IA' the spaces provided <br />are insufficient, use additional sheets, keying information to the proper <br />item numbers: <br />1. Do4dZ41. $7-aYtrW 11A /J50H �10 <br />Name of Owner: (First) (Middle) (Last) (Phone) <br />2. <br />3. <br />4. <br />sue' vl�� /I%1•cJ.(� <br />Address of Owner: (No. and Street) (City) (State) (Zip) <br />goo" S'�- <br />Name of Applicant: (First) (Middle) (Last). (Phone) <br />•6-4m 4r' <br />Address of Applicant; (No. and Street) (City) (State) (Zip) <br />5. SM 4L A/. Co . A& _O - <br />Street Address of Property Involved: <br />7�6. Complete Legal Description of Property Involved: <br />Y-7. Date Property Acquired: Ol/, <br />8. Present Use of Property: &S, Proposed Use of Property: '..? P <br />9. Present Zoning of Property: Proposed Zoning of Property: <br />10. What plan or change makes this request necessary <br />r 1 <br />4 <br />11. What is the expected effect of the proposed change? (For example, on <br />property value$, health, safety, parking, traffic conditions, etc.), <br />`//A ",'e GU !/i '06 g-, A A� A- b'o / 7-4/ m L. 4,0 <br />