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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 $100 <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 Zoning 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 />Name of Owner: <br />2. <br />Address of Owner: <br />f-' 1-C. `�.1r�� ►L <br />(First) (M <br />(No. a <br />Name of Applicant: (First <br />Street) <br />le) <br />(City) <br />Last) (Phone) <br />') / ILIA : -s .i/ 3 <br />(State) (Zip) <br />(Middle) (Last) (Phone) <br />4 . ,� �s , ) �� 6/2M' / N= <br />Address of Applicant: (No. and Street) (City) (S+:ate) (Zip) <br />5. C Tv 5 t= eN Ll L <br />Street Address of Property Involved: <br />6. Complete Legal Description of Property Involved: <br />7. Date Property Acquired: (- ,� <br />8. Present Use of Property: Proposed Use of Property: <br />9. Present Zoning of Property: _ Proposed Zoning of Property: <br />11. <br />What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc..) <br />� �� , r'z `1j G r/l 0 P G R —C <br />