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1 0* 0 A (1-4 <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 />$100 <br />_ Division of Platted Lot <br />$50 <br />Special Use Permit <br />s Vacation of Right -of -Way <br />$100 <br />$100 <br />Relocation of Dwelling <br />Variance to Zoning Ordinance <br />$50 <br />$50 <br />Preliminary and Final Plat <br />$100 <br />i Minor Variance <br />$25 <br />Please complete form by typing or printing in ink. If the spaces provided <br />are insufficient, use additional sheets, keying information to the proper <br />item numbers: <br />Name of Owner: (First) (Middle) (Last) (Phone) <br />2. <br />Address of Owner: (No. and Street) (City) <br />3. /V? <br />Name o <br />Applicant: (First <br />7--�t,17 . <br />(Middle <br />Address of Applicant: (No. and Street) (City) <br />5. / "-v ' 0-%Zl , /40, 0 <br />Street Address of Property Involved: <br />6. <br />7. <br />2 <br />9. <br />Complete Legal Description of Property Involved: <br />_ ._ i I^ — _ r .... 1 1 z _ a� -r n n 1 _ L E� //G! � - L <br />R,9S � 65 •»7� j o f .sFc y TW 9 6e A 3 <br />(Last) <br />State) (Zip) <br />,Ire <br />(Phone) <br />(State) (Zip) <br />21 7 <br />Date Property Acquired: <br />Present Use of Property: Proposed Use of Property: <br />Present Zoning of Property: Proposed Zoning of Property: <br />What plan or change makes this request necessary? <br />s-T ,�7/4ty�s� ,oi�7r <br />What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />-f <br />