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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 <br />$100 <br />Division of Platted Lot <br />$50 <br />Special Use Permit <br />$100 <br />Relocation of Dwelling <br />$50 <br />Vacation of Right -of --Way <br />$100 <br />_ <br />Variance to Zoning Ordinance <br />$50 <br />_ <br />Preliminary and Final Plat <br />$100 <br />Minor Variance <br />$25 <br />Please complete form by typing or <br />are insufficient, use additional <br />item numbers: <br />1. <br />2. <br />3. <br />4. <br />5. <br />printing in ink. If the spaces provided <br />sheets, keying information to the proper <br />33-70.55 <br />Name of Owner: <br />(First) (Middle) <br />(Last) <br />(Phone) <br />_ <br />(::'65C J 1 <br />cW L E <br />M AI) GS- 1 !3 <br />Address of Owner.- <br />(No. and Street) <br />(State) (Zip) <br />jj(City) <br />1(Last) <br />Name of Applicant: <br />(First) (Middle) <br />(Phone) <br />Address of Applicant: (No. and Street) (City) <br />(State) (Zip) <br />Street Address of Property Involved: <br />6. Complete Legal Description of Property Involved: <br />7. Date Property Acquired: .�.a <br />c� r• <br />8. Present Use of Property: C`��Sj�VLV44t Proposed Use of Property:1� +' <br />9. Present Zoning of Property: l MI5 R--: oposed Zoning of Property:'WM <br />10. What plan or change makes this request necessary? t>T e r (0A.J C <br /><5" tit <br />11. What is the Expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />t.1 J 1 C... �°'tc"'. t p itJ �1J 1 +t 1 i' E T ® Z , 4- <br />w <br />