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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 />1. �'3 (v- <br />Name of Owner: (First) (Middle) (Last) (Phone) <br />Address of owner: (No. and Street) (city) (State) (zip) <br />Wr <br />3. <br />Name of Applicant: (First) (Middle) (Last) (Phone) <br />4. <br />Address of Applicant: (No. and Street) (City) (State) (Zip) <br />%,r-- <br />5. <br />Street Address of Property Involved: <br />6. Complete Legal Description of Property Involved: <br />Low E4 \,LAZ jjj9jh:C.L <br />1A1-y-(X Ict <br />rl'. r 1', I Ck -17 <br />I <br />