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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 />_ $100 _ Relocation of Dwelling $50 <br />Special Use Permit <br />Vacation of Right -of -Way $100 Variance to Zoning Ordinance $25 <br />Preliminary and Final Plat $100 Minor Variance <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 • 11 � Y;/v ht?A (Last) (Phone) <br />Name of Owner: (First) (Middle) <br />2. - + (..�)— <br />)C Sta-ce ) (Zip) <br />Address of Owner, /(No. and Street) (City) (� %p <br />`_3. <br />)C 4. <br />5. <br />x 6. <br />11. <br />Name of Applicant: (First) (Middle) <br />A dress of Applicant: (No. and Street) <br />�A -- I I �p(�(iCity) <br />Street Address of Property Involved. <br />Complete Legal Description of Property Involved: <br />(Last) (Phone) <br />( StatPPe ) (Zip) <br />Date Property Acquired: <br />Present Use of Property: <br />Proposed Use of Property: <br />Present Zoning of Property: Proposed Zoning of Property: <br />What plan or change makes this reLques/t ne�cyessary? �G 1y.��� ��✓�a� <br />What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />