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CITY OF ROS£VTLL£ <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 />_ <br />Special Use Permit <br />$100 <br />Relocation of Dwelling <br />$50 <br />_ <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 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. / , (l� Jay. <br />Address of Owner: <br />p(e.sker- <br />(First) (Middle) <br />la,(\ LC <br />No. and Street) <br />3-3 - 6 <br />(Last) (Phone) <br />Se Q OW 550-3. <br />(City) (State) (Zip) <br />3. <br />Name of Applicant: (First) <br />(Middle) (Last) (Phone) <br />4. <br />Address of Applicant: (No. <br />and Street) (City) <br />(State) (Zip) <br />5. <br />Street Address of Property <br />Involved: <br />6. <br />Complete Legal Description <br />of Property Involved: <br />7. <br />Date Property Acquired: kakt <br />8. <br />Present Use of Property: <br />Proposed Use of <br />Property: <br />9. <br />Present Zoning of Property: <br />Prop,Dsed Zoning <br />of Property: <br />10. <br />makes this reque necessary? <br />Wha plan o%uc <br />chanAak <br />G� on UCH c v ��2Y1C� . <br />C,Qn���'�jC.cJ►1 <br />11. What is the expected effect of the proposed change? (For example, on <br />r perty values health, saf ty, parking, tra is conditions, etc.) <br />PT w ou �ess o i ro v� C. <br />ARo c,J e eo r <br />r <br />