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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 $1.00 <br />— Special Use Permit $100 <br />_ Vacation of Right -of -Way $100 <br />Preliminary and Final Plat $100 <br />Division of Platted Lot $50 <br />— Relocation of Dwelling $50 <br />_ Variance to Zor;ing Ordinance $50 <br />Minor Variance $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 />/ <br />R f t4t ,4 R-D .p • ko -rds <br />2. <br />3. <br />Name of Owner: (First <br />o t 5-70 Al. 6 r c, rtv <br />oZC9-o / /?A i A 2 C -T <br />Address of Owner: <br />e,'i <br />tNo. an <br />Name of Applicant: (First) <br />4. o� <br />(Middle)/ (Last) (Phone) <br />o ,r e- vi � ,+01/V. / 3 <br />A/ re..-..)s v, lCi ,ic-l---j s—r3 3 -) <br />(City) (State) (Zip) <br />D3 r- r 7r `7/ Y- <br />(Last) (Phone) <br />yr �Z 11,1,I. rj--1 / 3 <br />Haaress or Applicant: (No. and Street) (City) (State) (Zip) <br />Street Address of Property Involved: <br />6. Complete Legal Description of Property I voled: /�� G✓r� ST— / j —2- <br />�— O ..Sc ci72f //i --- _ <br />7�••� .S � � � i4�v�_ 2� <br />Street) <br />.8- <br />(Middle) <br />rt1 •. CG ('cq 4 <br />.7. <br />Date Property Acquired: <br />8. <br />Present Use of Property: <br />� <br />Use of <br />a <br />Property: <br />9. <br />Present Zoning of Property: Proposed <br />Zoning <br />of Property: lee --a- <br />10. <br />Wch�at lan or change mak s this request neces7 y? <br />r 7-o <br />70 <br />11. <br />What is the expected effect of the proposed <br />change? <br />(For example, on <br />rop--rty values, health, <br />rro <br />safety, parking, traffic conditions, <br />F-ATYNA <br />etc.) <br />y- �/o-1 e-s A,- D jv re— <br />7c d <br />e oAL <br />ems- <br />II <br />� <br />