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[I <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota 55113 <br />Please check item or items for which you are applying: <br />$100 Division of Platted Lot $50 <br />50 <br />_ Rezoning $100 Relocation of Dwelling <br />Special Use Permit ,Variance to Zoning Ordinance $50 <br />Vacation of Right -of -Way $100 $25 <br />_ Preliminary and Final Plat $100 � Minor Variance <br />in or printing in ink. If the spaces provided <br />Please complete form by typing <br />are insufficient, use additional sheets, keying information to the proper <br />item numbers: -lqo-o7E-7 <br />1. (Phone) <br />2. <br />3. <br />4. <br />Name of Owner <br />dress of Owner: <br />Name of Applicant: <br />First) <br />dress of Applicant: <br />(Middle) <br />No. and Street) (City) <br />Z L /0 <br />First) <br />;Middle) <br />Last) <br />(State F (ZiP) <br />(Last) <br />(Phone) <br />TS113 <br />(No. and Street) (City) (State) (Zip) <br />5. 2 C� /�7Ff 7�. Z) .9 , <br />f <br />Street Address of Property Involved. <br />6. Complete Legal Description of Property Involved: <br />1711 7'6 6 6- o. Cs iT�S <br />7. Date Property Acquired: Z <br />. Present Use of Property: ��s���'roposed Use of Property: �'� <br />9. Present Zoning of Property: <br />/ proposed Zoning of Property:—U----� <br />10. What plan or change makes this request necessary? �I VIP of tcx IL <br />rt <br />v <br />11. What is the expected effect of the etraffic conditions, ange? (For example, <br />property values , health, safety, parking, <br />,�/'�. �. �_7 • G.Ki` f`�-, •�-'� ��64�-4���� � C �C Q� Q'���-l/��" �s.�/ifJ / ��� <br />� Ctr. <br />