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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 <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 -V� Minor Variance <br />$25 <br />Please complete form by typing or printing in ink. If the spaces <br />are insufficient, use additional sheets, keying information to the <br />item numbers: y g proper <br />1. e <br />Name of Cwner: (First) Mi. cam) Last ) w ! <br />s (Phone <br />2 . <br />4/ <br />Address of Owner: (No. and Street) <br />(City) (State) <br />Name of Ap licant: (First) (Middle) (Last) <br />(Phone) <br />4. <br />Address of Applicant: (No. and Street) (City) (State) (Zip) <br />Ma 6111VC1 <br />Street Address of Property Involved: <br />6. C plete Let escril ion fropert Involved . r <br />jE <br />7. Date Property Acquired: <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 1 <br />7�:-"this request necessary? <br />..r „e.� ,% . y <br />11. What is the expected effect of the <br />propert va es, health, safety, proposed change? (For example, on <br />Y ('fit , !/ih /I✓,L'/J�f t�� par k� of f conditions <br />I -.�, <br />14 <br />