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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 <br />Special Use Permit <br />$100 <br />Division of Platted Lot <br />$50 <br />_ <br />__. Vacation of Right -of -Way <br />$100 <br />$100 <br />Relocation of Dwelling <br />Variance to Zoning Ordinance <br />$50 <br />$50 <br />_ Preliminary and Final Plat <br />$100 <br />_ 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: proper <br />1. <br />2. <br />3. <br />4. <br />5. <br />Name of Owner: <br />Address of Owner: (No. and Street <br />Name of Applicant: (First) (Midc <br />(First) (Middle) <br />/�/ -F ��'4p /( 3' <br />(City) <br />Ale /- - -Z; -, Z' <br />le) <br />Address of Applicant: (No. and Street) <br />Street Address of Property <br />?7)41-2�> <br />involved: <br />(Last) (Phone) <br />State) (Zip) <br />/ (Last) <br />Last))) _ (Phone) <br />Pone) <br />AKX4:�- <br />(City) (State) (Zip) <br />6. Comp l to Legal DeS cWtj'on of Property Involved: <br />7. Date Property Acquired: / <br />8. Present Use of Property:/G-�"-/Fr-�e�-eproposed Use of Property: <br />9. Present Zoning of Property: Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? A <br />11. What is the expected effect of the proposed change? (For example, on <br />property <br />>values health, safety, parking, traffic conditions, etc.) <br />