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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 <br />Special Use Permit $100 <br />_ Vacation of Right -of -Way $100 <br />_ Preliminary and Final. Plat $100 <br />Division of Platted Lot $50 <br />_ Relocation of Dwelling $50 <br />�C Variance to Zoning Ordinance $50 <br />_ Minor lariance $25 <br />Please complete form by typing or printing in ink. If the spaces <br />are insufficient, use additional sheets, keying information to the prrrovoperoperd <br />item numbers: <br />1 <br />Name of Owner: (First) (Middle) <br />(Last) (Phone) <br />2. <br />A drelie I <br />ss of 04; ner : ( No . and Street) f <br />(City) (State) (Zip) <br />• ic -� C� Syr ear --...'3 ' <br />Name of Applicant: (First) (Middle) <br />(Last) (Phone) <br />4. <br />Address of Applicant: <br />(No. and Street) (City) (State) (Zip) <br />5. <br />Street Address of Property Involved: <br />6. Complete Legal Description f Property Involved: <br />d = $ 143 o i� <br />� f <br />t. rti <br />7. Date Property Acquired:' , ''�',� -p "' F'�' a <br />8. Present Use of Property: (� ®p�� H041,° /��r1.7 <br />E- roposed Use of Property • clJ o tg <br />ert 1063T A`°ni � <br />9 . Present Zoning of Property: Y: Proposed Zoning of Property: <br />0. What plan or .change makes this request necessary? <br />! e{ e: <br />11. What is the expected effect of the <br />property values, health, safet Proposed change? (For example, on <br />y, parking, traffic conditions, etc.) <br />