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CITY OF ROSEVILLE <br />' 2660 Civic Center Drive <br />Roseville, Minnesota 55113 <br />Please check item or items for <br />/ /-- <br />which you <br />are applying: <br />$100 X <br />Division of Platted Lot <br />Dwelling <br />50 <br />$50 <br />Rezoning <br />— Special Use Permit <br />$100 _ <br />$100 <br />Relocation of <br />Variance to Zoning Ordinance $50 <br />$25 <br />�_ Vacation of Right -of -Way <br />Final Plat <br />$100 <br />Minor Variance <br />s Preliminary and <br />or printing <br />in ink. If the spaces <br />pr�voie�d <br />Please complete form by typing <br />additional sheets, <br />keying information to the <br />p P <br />are insufficient, use <br />item numbers: �---7 <br />r /) A 4 n . i I e--e& -Io <br />fag <br />1. <br />2. <br />3. <br />Name of Owner: <br />ess of Owner: <br />Name of Applicant: <br />4: <br />Address o� <br />5. <br />Street Ad <br />_____— <br />(First) <br />(Middle) <br />eos&lle /%- <br />No. and Street) <br />Applicant: <br />Last) (Phone) <br />(City) koLaI.C/ %"-n'I <br />First ) <br />(Phone) <br />No. and Street) (City) <br />(State) (Zip) <br />dress of Property Involved: <br />6. Complete Legal Description of Property Involved: <br />7. Date Property Acquired: 9 7U <br />�v <br />,��� Proposed Use of Property:i6brl1E� <br />8. Present Use of Property S J�,�yZe <br />9. Present Zoning of Property: <br />, Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? Tf�✓?`�-- <br />T <br />11. <br />What is the expected effect rof the 'pIr i nri t raf f icchange? <br />conditions , etc.) <br />on <br />