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41 <br />r <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 <br />Division of Platted Lot <br />$50 <br />_ Rezoning <br />Special Use Permit <br />P <br />$100 <br />_ <br />_ Relocation of Dwelling ordinance <br />to oni g <br />$50 <br />_ <br />Vacation of Right -of -Way <br />$100 <br />$100 <br />X Variance <br />Minor Variance <br />$25 <br />Preliminary and Final Plat <br />_ <br />Please complete form by typing or printing in ink. If the spaces provided <br />are insufficient, use additional sheets, keying information to tie proper <br />item numbers: <br />1• G (� A NC (Last) (Phone) <br />Name of Owner: (First) (Middle) <br />2. Address of Owner: (No. and Street) (City) <br />(State) (ZAP) <br />3. ldl6e) Phone) <br />Name of Applicant: (First) ( (Last) <br />c <br />4. ? 7� G <br />licant: (No. and Street) (City) (State) (Zip) <br />Address of App. r <br />5. <br />Street Address of Property <br />6. Complete Legal Description of Property Involved: <br />7.' Date Property Acquired: <br />,2i.�w v r S ENI.,,�'�'sNi� <br />8. Present Use of Property: <br />Proposed Use cf Property: <br />9. Present Zoning of Property: <br />Proposed Zoning of Property: <br />___-L...--- t-h; c request necessary? <br />10. <br />11, What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />Ak i 4-L 72LI ? W-& Ala <br />