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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 />Y Division of Platted Lot <br />$50 <br />_ <br />Special Use Permit <br />$100 <br />_ Relocation of Dwelling <br />$50 <br />_ <br />Vacation of Right -of -Way <br />$100 <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 printing in ink. If the spaces provided <br />are insufficient, use additional sheets, keying information to the proper <br />item numbers: <br />1. -5 2 ,- P, -S tA- �- ; e' <br />Nabe of Owner: <br />2. 3%/0 (LcvE( <br />Address of Owner: <br />3. Ink A e 4 <br />Name 6f Applicant: <br />4. <br />(First) <br />,¢-'-'� ' <br />(No. an <br />Address of Applicant: <br />First) <br />jAP <br />(Middle) (Last) (Phone) <br />Street) (city) ( Stra.°.'e ) (Zip) <br />(Middle <br />No. and Stree <br />(Last) (Phone) <br />(City) (State) (Zip) <br />5. 6� U <br />Street Address of Property Involved: <br />6. Complete Legal Description ct Property Involved: <br />7. Date Property Acquired: <br />8. Presen Use of Property: c•�; �.,, r- Proposed U of Property: <br />9. Present Zoning of Property: Proposed Zoning of Property: N �. <br />10. What plan or change makes this request necessary? <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />9-0 ".e5 40L614 <br />