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w <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 <br />Platted Lot <br />$50 <br />Special Use Permit <br />$100 <br />- Relocation <br />of 'Dwelling <br />$50 <br />Vacation of Right-of-way <br />$100 <br />Variance to <br />Zoning Ordinance <br />$50 <br />_ <br />Preliminary and Final Plat <br />$100 <br />Minor Variance <br />$25 <br />Please complete form by typing <br />or printing in ink. <br />If the spaces <br />provided <br />are insufficient, use additional <br />sheets, keying information <br />to the <br />proper <br />item numbers: <br />j <br />Name of Owner: (Fi <br />st) <br />(Middle) <br />(Last) <br />(Phone) <br />2 . :K ct �{ Sd . <br />Address of Owner: <br />3. <br />Name of Applicant: <br />(No. and Street) (City) (St te) (Zip) <br />(First) (Middle) <br />(Last) <br />Phone) <br />4. S&rye <br />Address of Applicant: (No. and Street) (City) (State) (Zip) <br />5. &� S � , % fi e Fi�v,'s V ' d, axe, <br />Street Address of Property Involved: <br />6. Complete Legal Description of P operty Involved: <br />)C 7. Late Property Acquired: Sc_-FT, 2 S, «g% <br />8. Present Use of Property: Proposed Use of Property: <br />9. Present Zoning of Property:_ Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? , <br />W_ <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />