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11 <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota 55113 <br />• <br />Please check item or items for which you are applying: <br />Rezoning $100 _ Division of Platted Lot $50 <br />$100 Relocation of Dwelling <br />Special Use Permit $50 <br />_ Vacation of Right -of -Way $100 .— Variance to Zoning Ordinance $25 <br />_jZ 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 />�-- .� � L LNhi 33-3�,,30 <br />1. G (Last) (Phone) <br />Name of Owner: (Firs ) (Middle) <br />2. State) (Zip) <br />Address of Owzier: �(No4an!ASreet)(City) <br />3. (Last) (Phone) <br />Name of Applicant: (Fir (Middle) <br />4, ' State) (Zip) <br />Address of pplicant: (No. and Street) (City) <br />5. <br />Street Address of Property Involved: <br />6. Complete Legal Description of Property Involved. GQZ EZ: <br />7. Date Property Acquired: ZY U pj <br />S/ A71, I-r Si' 7 A <br />8. Present Use of Property: �A <br />Proposed Use of Property:A9 <br />g. Present Zoning of Property: -- <br />Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? -6 W. ae-2 <br />11. What is the expected effect of the proposedraff ic ge? (For <br />Fo examditionsretc,)on <br />property values, health, safety, parking, <br />