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CITY OF ROSEVILLE <br />2660 CiviNlinnesotaDrive <br />55113 <br />Roseville, <br />You are applying: <br />please check item or items for which Y platted Lot $50 <br />Ple Division of $50 <br />$100 — Relocation of Dwelling <br />Rezoning $100 _ Ordinance $$25 <br />Special Use Permit $100 Variance to Zoning <br />Vacation of Right -of -Way Minor Variance <br />preliminary and Final Plat $100 he spaces provided <br />Pre in ink . I f t <br />or printing information to the proper <br />Please complete form by typing keying <br />are insufficient, use additional sheets, <br />item numbers : QdA <br />t� LL' (Middle) <br />(Last) (Phone) <br />1. (First). <br />Name of owner : �6.' 13 <br />�y�L�!' 10 <br />(state) (zip) <br />( City ) <br />2. No . and Street ) 3 L1=� <br />Address of Owner: ( <br />r 11,!Ijj!J0 1111 �DQ (Last) (Phone) <br />3. ` (First) <br />(Middle) <br />Name of Applicant: <br />` an, <br />AddStreet) (City) (State) (Zip) <br />4. of Applicant: (No. a <br />res� <br />5. erty Involved: <br />Street Address of Prop Involved• <br />L <br />Complete Legal Description of Property ' <br />6. <br />Acquired: AAY_=/1 <br />7. - <br />Date Property Property: Proposed Use of Prop <br />g, Present Use of Property: Proposed Zoning of Property: <br />e r ty : ______— <br />g , Present Zoning of Prop 0 Q 0 F,L 2—AAk <br />e makes thiIf ji <br />s request necessary? r, <br />10 . What plan or Chang ,��C �l,Ji4 y sf� <br />�tlSTl✓ �d — <br />For example, on <br />ro osed change. ( etc.) <br />What is the expected effect of theapking, traffic conditions, �tGN Ta <br />11. values , health, safety, parking, <br />k, ��,/�/¢�k� <br />property s x d' A <br />