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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 />$1.00 _ <br />Division of Platted Lot <br />$50 <br />Special Use Permit <br />$100 _ <br />Relocation of Dwelling <br />$50 <br />Vacation of Right -of -Way <br />$100 <br />Variance to Zoning Ordinance <br />$50 <br />_ <br />Preliminary and Final Plat <br />$100 <br />Minor Variance <br />$25 <br />Please complete form by typing <br />or printing in ink. If the spaces <br />provided <br />are insufficient, use additional sheets, <br />keying information to the <br />proper <br />item numbers: <br />Name of Owner: <br />16L v 0 ii e .� •' <br />(First/) (Middle) <br />CC' h If h /71(t I bY. <br />ress or uwner: (No. and Street) <br />Name o <br />L cd. j <br />Applicant: (First) (Middle) <br />Address <br />of Applicant: <br />(No. <br />and Street) <br />5. C/ <br />G-1 b <br />f e <br />-by <br />he. v n 6 3 3 y.sso <br />Last) (Phone) <br />Kvse ;rye- Al Al it <br />City) (State) (Zip <br />(City) <br />(Last) <br />(Phone) <br />/VI A/ --'�-/ <br />(State) (Zip) <br />Str— ee Address of Property Involved: i�ty b, A�-o <br />6. Complete Legal Description of Property Involved: tjtq -23 3Z 0 <br />7. Date Property Acquired: IqX K <br />8. Present Use of Property: y �c� n� _Proposed Use of Property: ye S ;cle "t e, <br />9. Present Zoning of Property: kc' S . Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? & dd;t ;8 n e <br />a n t+ h C I lA i rn % <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />