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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 _ Division of Platted Lot $50 <br />Special Use Permit $100 Relocation of Dwelling $50 <br />_ Vacation of Right -of -Way $100 _ Variance to Zoning Ordinance $50 <br />_ Preliminary and Final Plat $100 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: (First) (Middle) , (Last) �J,� (Phone) <br />2 . /�/.3.2 �i9L /S° l�/Ii �2 Gi 'dam A oyc-y-,11- �'%'//��i�'� 55//3 <br />Address of Owner: (No. and Street) (City) (State) (Zip) <br />3 . 6 ,j 4 -�Z <br />Name of Applicant: (First) (Midd (Last) (Phone) <br />4 . <br />Address of Applicant: (No. and Street) (City) (State) (Zip) <br />5. %j/3 ,;2 TAL,1,1.11Ar1 C fek;— <br />Street Address of Property Involved: J <br />6. Complete Legal Description of Property Involved: <br />o C P!3- k' k, <br />7. Date ProFArty Acquired: •J E'0I-k-nf'i>4 IeF%? <br />8. Present Use of Property:Proposed Use of Property:��ES'�A� <br />9. Present Zoning of Property: �_ Proposed Zoning of Property:_ <br />10. What 11an or change makes this request necessary? r 6!y R C t-E�cZE <br />E 1 ReE A V P 1 01 R o v E` © L u AV6�- S o 6'/ E— <br />o ,v <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />4EE- 5c7,&f F,,f,91V i9 Jvt 411 !3 aevrx <br />5-re4zz 7- AND -rRA FF /d. CA) 60,W417Y <br />j�tc�S y�i�.vL/��rs o•y �oeucks �Ac.F�iv� �,�%mod Dmc� aoa.�s ,ram <br />R -r Fj- PC �! S / n/ � u �T k' � � S • Gvf� io ti' � S� <br />P1 Pe-c -7 y f}CRo53 1S',rc �=w �awA <br />f� EhJ W l /✓ t� co tv s <br />